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A case of carotenemia associated with ingestion of nutrient supplements
Abstract
Carotenemia is characterized by an abnormal yellowish orange pigmentation of the skin, most prominently seen on the palms and soles. Although it is associated with several disease such as diabetes, hypothyroidism and anorexia nervosa, it is caused by excessive intake of carotene-rich food such as oranges and carrots in most cases. Herein, we describe an interesting case of carotenemia in a 66-year-old female secondary to increased ingestion of oral supplements of carotene in order to improve hemorrhage in the eyeground. There could be an increasing trend of intake of commercial nutrient supplements in which case it is necessary to remind ourselves that commercial nutrient supplements could cause various skin disorders as side-effects.
... This is most seen in babies with too much carrot in alimentation (especially juice). Columbia University's Health Services department point out that an intake of over 20 mg of beta carotene, is enough to set off hypercarotenemia [4]. ...
... Hypercarotenemia can sometimes be an indicator of anorexia nervosa [4]. ...
... • Diabetes mellitus is well known today to cause yellow discoloration of the palms and soles [2,5]. • Childhood hyperlipoproteinemia (Table 1); • The various phenols, quinoline, diphenyls found in many hair lotions are photoactivated, and condensed to form polynuclear quinonoid compounds which are often colored and can induce transitory yellow coloration of the palms [6]; • The explosive trinitrotoluene (TNT) when it was handled for hours, by workers during the World War I, induced yellow skin over the palms; the women at those times were called "Canary Girls"--due to "nitro groups" within the TNT that reacted with melanin in the workers' skin (2008 paper in the Chemical Educator Journal); • Sorafenib-Sunitinib are two drugs with known adverse reaction of yellow skin discoloration [4]; • Myxedema also can be associated with yellow skin and but not limited to the palms and soles [7]; ...
The yellowish discoloration of the palms and skin is reported under different terms: xanthodermia, hypercarotenemia, carotenemia, carotenodermia. Yellow discoloration of the skin may be associated with carotenemia, hypothyroidism, diabetes mellitus, hyperlipoproteinemia, liver disease, and renal disease, meaning that carotenemia is not synonym with yellow skin, but rather one of the cause. We presented an 8 year‐old boy with a yellow discoloration of the palms and soles, observed by the mother 3 weeks prior to medical examination. The discoloration was uniformly distributed, rather symmetrically, no nails changes, just a mild xerosis palmaris on the right hypotenar area. In lab investigations only were: hypercholesterolemia. The final diagnosis was xanthodermia in context of hyperlypoproteinemia type II A.
... This is most seen in babies with too much carrot in alimentation (especially juice). Columbia University's Health Services department point out that an intake of over 20 mg of beta carotene, is enough to set off hypercarotenemia [4]. ...
... Hypercarotenemia can sometimes be an indicator of anorexia nervosa [4]. ...
... • Diabetes mellitus is well known today to cause yellow discoloration of the palms and soles [2,5]. • Childhood hyperlipoproteinemia (Table 1); • The various phenols, quinoline, diphenyls found in many hair lotions are photoactivated, and condensed to form polynuclear quinonoid compounds which are often colored and can induce transitory yellow coloration of the palms [6]; • The explosive trinitrotoluene (TNT) when it was handled for hours, by workers during the World War I, induced yellow skin over the palms; the women at those times were called "Canary Girls"--due to "nitro groups" within the TNT that reacted with melanin in the workers' skin (2008 paper in the Chemical Educator Journal); • Sorafenib-Sunitinib are two drugs with known adverse reaction of yellow skin discoloration [4]; • Myxedema also can be associated with yellow skin and but not limited to the palms and soles [7]; ...
The yellowish discoloration of the palms and skin is reported under different terms: xanthodermia, hypercarotenemia, carotenemia, carotenodermia. Yellow discoloration of the skin may be associated with carotenemia, hypothyroidism, diabetes mellitus, hyperlipoproteinemia, liver disease, and renal disease, meaning that carotenemia is not synonym with yellow skin, but rather one of the cause. We presented an 8 year-old boy with a yellow discoloration of the palms and soles, observed by the mother 3 weeks prior to medical examination. The discoloration was uniformly distributed, rather symmetrically, no nails changes, just a mild xerosis palmaris on the right hypotenar area. In lab investigations only were: hypercholesterolemia. The final diagnosis was xanthodermia in context of hyperlypoproteinemia type II A.
... Preparaty takie zawierają główne β-karoten, likopen, luteinę i zeaksantynę (13). Liczne badania wskazują, że spożywanie pokarmów zawierających duże ilości karotenoidów, takich jak owoce kaki, surowa marchew i pomidory, może prowadzić do zmiany zabarwienia skóry na odcień pomarańczowy (14)(15)(16), który po zaprzestaniu spożycia tych produktów zanika, a skóra wraca do naturalnego zabarwienia (14)(15)(16). Karotenoidy także chronią skórę przed promieniowaniem UV (17). ...
... Preparaty takie zawierają główne β-karoten, likopen, luteinę i zeaksantynę (13). Liczne badania wskazują, że spożywanie pokarmów zawierających duże ilości karotenoidów, takich jak owoce kaki, surowa marchew i pomidory, może prowadzić do zmiany zabarwienia skóry na odcień pomarańczowy (14)(15)(16), który po zaprzestaniu spożycia tych produktów zanika, a skóra wraca do naturalnego zabarwienia (14)(15)(16). Karotenoidy także chronią skórę przed promieniowaniem UV (17). Zauważono, że spożycie pasty ...
... Moreover, a yellow-orange colouration of the soft palate is easily identifiable in subjects with ED, as in this area the mucosa is thinner and allows a better visualisation of the underlying connective tissue colour. This staining is caused by carotenemia, an increase in serum carotene level, which is described with high frequency at soft palate level in patients with ED who have a diet rich in carotenoids or who abuse vitamin A analogue supplements [Takita et al., 2006;Panico et al., 2018]. ...
Aim:
To evaluate the effects of tongue frenulectomy performed with two therapeutic approaches: Laser frenulectomy and combined laser and speech-language therapy.
Materials and methods:
The study involved 180 patients (90 males and 90 females) aged between 6 and 12 years. After examination and data collection, the patients were stratified according to three degrees of severity: mild, moderate and severe. After treatment, the test group (laser frenulectomy and combined laser and speech-language therapy) was compared with the control group (laser frenulectomy) in the pre-surgical phase, at one week, 1 month, 3 months, 6 months and 12 months after surgery.
Results:
Statistical analysis showed statistically significant differences between the pre-surgical and post-surgical values at 3 months, 6 months and 12 months after surgery (p<0,05).
Conclusions:
It is essential to establish diagnosis criteria to which the clinician should refer in order to decide the treatment plan. This study shows that combined laser and speech- language therapy leads to better results than the resection treatment of the frenulum with laser technique alone.
... Excessive intake of these carotene-rich foods or other nutritional supplements containing carotene can lead to carotenemia. 3 Carotenoids are absorbed and cleaved by the intestinal mucosal enzyme into two molecules of retinal. 4 We report a case of hypercarotenaemia in a hypothyroid female. ...
... Excessive intake of these carotene-rich foods or other nutritional supplements containing carotene can lead to carotenemia. 3 Carotenoids are absorbed and cleaved by the intestinal mucosal enzyme into two molecules of retinal. 4 We report a case of hypercarotenaemia in a hypothyroid female. ...
Hypercarotenaemia develops in person consuming high amount of carotenoid rich foods. It is also known that person with hypothyroidism and diabetes mellitus tend to develop hypercarotenaemia with the normal intake of carotenoid rich foods. This case is of hypercarotenaemia in adult Nepalese hypothyroid women who consumed excess amount of food rich in carotene in order to get rid of her jaundice. Our common food habits can cause ill health effects if not monitored.
... También se informaron casos de carotenemia con el consumo de suplementos nutritivos y alimentos procesados, así como de alimentos naturales que contienen carotenoides. 6,7 Si no se observa que la dieta sea causa de la carotenemia, el médico debe considerar otras afecciones, como diabetes mellitus, hipotiroidismo, anorexia nerviosa, hepatopatía y nefropatía. 3 En general, el diagnóstico diferencial puede establecerse fácilmente con una buena historia clínica, un examen físico y análisis de laboratorio sencillos. ...
... Cases of carotenemia have also been reported with nutrient supplements and processed foods as well as natural foods containing carotenoids. 6,7 If diet is found not to be responsible for the carotenemia, the physician should consider conditions including diabetes mellitus, hypothyroidism, anorexia nervosa, liver and kidney disease. 3 Generally, differential diagnosis can be performed easily by a good history, physical examination and simple blood tests. ...
Carotenemia is generally benign and usually caused by excessive intake of beta-carotene rich food. This clinical presentation can occur in any age group but frequently occurs in children. We report a rare case of carotenemia with an isolated involvement of the nose and presented in order to remind carotenemia in the differential diagnosis of jaundice. Carotenemia is often easily recognized and dealt with by family medicine and pediatricians who may potentially get
involved in the management of these cases. It is also important to know and recognize carotenemia in terms of informing families and preventing unnecessary tests.
... Cases of carotenemia have also been reported with nutrient supplements and processed foods as well as natural foods containing carotenoids. 6,7 If diet is found not to be responsible for the carotenemia, the physician should consider conditions including diabetes mellitus, hypothyroidism, anorexia nervosa, liver and kidney disease. 3 Generally, differential diagnosis can be performed easily by a good history, physical examination and simple blood tests. ...
Carotenemia is generally benign and usually caused by excessive intake of beta-carotene rich food. This clinical presentation can occur in any age group but frequently occurs in children. We report a rare case of carotenemia with an isolated involvement of the nose and presented in order to remind carotenemia in the differential diagnosis of jaundice. Carotenemia is often easily recognized and dealt with by family medicine and pediatricians who may potentially get involved in the management of these cases. It is also important to know and recognize carotenemia in terms of informing families and preventing unnecessary tests.
Sociedad Argentina de Pediatría.
... 40 Carotenemia and lycopenemia are more accentuated on the palms and soles because the stratum corneum is thicker in these regions. 41 Discoloration of palms and soles is consequence of pigment deposit due to slow conversion of carotenoids to vitamin A. [42][43][44][45] In another case, a 68-yearold Caucasian female was presented with red-orange tinged skin of the palms and soles. Her diet includes 1 kg of kaki fruit daily. ...
Purpose
Carotenoids, especially lutein and zeaxanthin isomers (L/Zi), filter blue light and protect skin from environmental factors including high-energy sources. These carotenoids may be able to block the formation of melanin pathways, decrease cytokines, and increase antioxidants.
Subjects and methods
This is a randomized, double-blind, placebo-controlled clinical trial over a 12-week supplementation period. Fifty healthy people (50 healthy subjects were recruited and 46 subjects completed the study) (males and females, age: 18–45 years) with mild-to-moderate dry skin were included in this study. Skin type of the subjects was classified as Fitzpatrick skin type II–IV scale. Subjects were administered with either an oral dietary supplement containing 10 mg lutein (L) and 2 mg zeaxanthin isomers (Zi) (L/Zi: RR-zeaxanthin and RS (meso)-zeaxanthin) or a placebo daily for 12 weeks. The minimal erythemal dose and skin lightening (L*) were measured via the Chromameter®. The individual typological angle was calculated. Subjective assessments were also recorded.
Results
Overall skin tone was significantly improved in the L/Zi group compared to placebo (P<0.0237), and luminance (L*) values were significantly increased in the L/Zi group. Mean minimal erythemal dose was increased with L/Zi supplementation after 12 weeks of supplementation. L/Zi supplementation significantly increased the individual typological angle.
Conclusion
L/Zi supplementation lightens and improves skin conditions.
... Chronic iron deficiency has resulted in spoon shaped nails (koilonychia), hair loss, glossitis with loss of papillae, angular cheilitis, and pruritus.11 Iron found in Liver, eggs, meat, dark and green vegetables, lentis, potatoes, soybeans, chick peas, black beans, spinach, etc. [29,50]. ...
In recent years nutritional deficiency diseases have been reported in developed countries. Nutritional deficiencies can be due to inadequate intake, abnormal absorption or improper utilisation. Many nutrients are essential for life, an adequate amount of nutrients in the diet is necessary for providing energy, building and maintaining body organs and for various metabolic process. Skin disorders have long been associated with nutritional deficiencies. Nutrition is one of the most important parameters that are involved in modulating skin health and condition. Nutritional status plays an important role in maintenance of healthy skin. A variety of nutritive factors such as small peptides minerals, vitamins, macronutrients and micronutrients work together to maintain the barrier functions of skin in the face of everyday challenges. Changes in nutritional status that alters skin structure and function can also directly affect skin appearence. In general dermatological problems were diet plays a role are atopic eczema, urticaria, dermatitis herpetiformis, psoriasis, pityriasis, rubra pilaris, purpura, scurvy, refsumes disease, ichthyosis, vitiligo, hypo pigmentary conditions, acne, rosacea, kwashiorkor, marsmus, stomatitis, phrynoderma, pellagra, acro dermatitis enteropathica, homocysteinuria, hartnup disease, gout, porphyrias, xanthomas, hyper carotenemia and lycopenemia. Dietary changes or modification might help to prevent recurrences of many skin diseases.
... A defective formation of the tooth enamel takes place and this may lead to abnormalities of dentine (Takita et al., 2006). ...
Vitamin A has important function in the body. Vitamin A is involved in vision, growth, and reproduction. In this paper, description, function and deficiency diseases of vitamin A has been delineated herewith.
... They can do so, however, if chronic alcoholism co-exists. It should be remembered that an excessive dietary intake of β-carotene can lead to carotenodermia, characterized by orange-yellow skin discoloration [109][110][111]. The lipophilicity of lipid soluble agents (drugs and micronutrients) actually accounts for many of the toxic effects of such preparations. ...
Vitamin A is an essential micronutrient for humans, meaning that it cannot be biosynthesized in the body and thus must be
obtained from dietary sources. Retinol is its vitamer form in food and is converted in the body to 11-trans-retinal by an oxidative process
where the hydroxyl group is converted into an aldehyde. 11-trans-retinal is subsequently isomerized into 11-cis-retinal, the functional
isomer of the vitamin important in the physiology of vision. In addition, this fat-soluble essential metabolite and its derivatives play vital
roles in the regulation of many metabolic and biological functions including growth and differentiation of cells, reproduction
(spermatogenesis, oogenesis, placental development and embryonic growth), and the regulation of the immune system. This micronutrient is
also an important antioxidant that performs a corner process necessary for protection against oxidative damage caused by free radicals
generated in several metabolic processes in the human body. The scavenging of free radicals is fundamental for the bodys fecundity and
well-being. In order to perform this, the vitamin needs to be supplied via natural dietary sources rich in this micronutrient. Hypervitaminosis
A and toxicity, which usually occur as a consequence of the administration of large amounts of vitamin A preparations, usually for
therapeutic purposes, can cause different serious discomforts and ailments through exertion of its oxidative properties. For vitamin A to
perform as a friend or a foe is a dose-dependent issue. Thus the micronutrient should be provided in balanced amounts so that the body can
deal with it safely and properly.
... Excess of various nutrients can also result in certain diseases. Carotenemia is caused by excessive intake of carotene-rich food such as oranges and carrots.[16] Xanthelasmas may be associated with hyperlipidemia.[17] ...
Many nutrients are essential for life, and an adequate amount of nutrients in the diet is necessary for providing energy, building and maintaining body organs, and for various metabolic processes. The role of food in the induction of various skin disorders and skin diseases leading to nutritional deficiencies is well known. The photo-protective potential of antioxidants, the effects of micronutrient supplementation on the skin immune system, and the modulating effects of fatty acids on skin disorders are well documented. Skin diseases due to nutritional deficiencies, the dietary role in skin immunity and various skin diseases, and the role of antioxidants and other supplements in skin health have been reviewed.
... For this reason, carotenemia, a term used to describe excess levels of carotene (a source of provitamin A) in the blood, has been described as being benign aside from the yellow pigmentation of skin. There have been several reports of benign carotenemia secondary to carrot ingestion, the most common cause of carotenemia, as well as dietary dried seaweed, green beans, and nutrient supplementation [14,17,26,27]. ...
This chapter deals with the introduction, classification and biological functions of vitamins. The deficiencies caused by water-insoluble vitamins such as vitamin-A, vitamin-D, vitamin-E and vitamin-K and water-soluble vitamins such as vitamin-C and the vitamin-B complex have been discussed in detail. The structure and properties of various types of vitamins are also part of this subject.
Black hairy tongue (BHT) is a “condition where the surface of the tongue takes a blackish discoloration (Fig. 12.1) and furry appearance due to abnormally hypertrophied and elongated filiform papillae (Fig. 12.2).
Background:
Hyperpigmentation is a common dermatologic problem that may have substantial impact on the patient, since it affects the appearance and quality of life, and may influence treatment adherence. There are few studies of drug-induced hyperpigmentation.
Methods:
We studied drug-induced hyperpigmentation in patients attending an outpatient dermatology clinic in the Western Area of Valladolid (Spain) from August 1, 2017 to April 20, 2018.
Results:
The incidence of drug-induced hyperpigmentation was 1.31% in patients attending a first dermatology consultation in the study period. Of the 16 patients, 8 were taking more than 1 drug. The most frequent drugs identified were nonsteroidal anti-inflammatory agents (25%), antihypertensive agents (18.75%), antimalarials (12.5%), antibiotics, antineoplastic agents, psychoactive agents, simvastatin, allopurinol, amiodarone and mucolytic (6.25% each). Hyperpigmentation was found in the mucosa in 25% of patients and in photograph-exposed areas in 37.5%.
Discussion:
Diagnosing drug-induced hyperpigmentation is a dermatologic challenge. A differential diagnosis with hyperpigmentation caused by endocrine and metabolic disorders, the most closely-related disorders to drug-induced hyperpigmentation, and with hyperpigmentation of idiopathic origin, should be conducted. Drug-induced hyperpigmentation is a relatively frequent reason for consultation, especially in polypharmacy patients. The sample may have been biased as many patients receiving treatments frequently associated with drug-induced hyperpigmentation, such as antineoplastic drugs, are diagnosed and treated by other specialties, such as oncologists.
Conclusion:
Family physicians and specialists should consider drugs as a cause of hyperpigmentation to facilitate the correct diagnosis and treatment.
A 29-year-old woman presented with a 6-month history of yellowing skin on her palms and soles. She was previously healthy, did not consume alcohol, and had no personal or family history of liver disease. She took no prescription medications; however, approximately 6 months prior to the onset of symptoms, she began taking a nutritional supplement (Nature Made Beta Carotene, Otsuka Pharmaceutical) manufactured in Japan and available online in China. This supplement contained 1.8 mg of beta carotene per tablet, and she had been taking 2 tablets daily for the past 6 months. She had no other dietary changes during this period, in particular, no increased intake of carrots or other yellow- or orange-colored fruits or vegetables. Physical examination revealed yellow-orange pigmentation of her palms and soles (Figure). There was no scleral icterus. Results of laboratory tests, including measurement of aspartate aminotransferase, alanine aminotransferase, hemoglobin A1c, and total and direct bilirubin levels, ratio of blood urea nitrogen to creatinine, as well as fasting lipid profile and thyroid function tests, were normal.
Medications have long been known to cause pigmentary changes of the skin. While this frequently occurs as post-inflammatory changes of a resolving drug-induced rash, medications can also directly promote dyspigmentation through stimulation of melanin production and/or deposition of drug (or drug metabolite) within the skin. Medications can also cause hypo- or depigmentation. Drug-induced pigmentary changes depend on factors such as the particular drug (or heavy metal) and level of deposition or melanocyte stimulation (or inhibition of melanogenesis). Drug-induced dyschromias have historically been categorized in a medication-class based manner. Because the clinician is generally faced with a patient whose chief complaint is dyspigmentation (which comes in varying shades), we propose a color-based approach for understanding drug-induced dyschromias.
Deep malnutrition in patients with eating disorders can negatively influence function of all organs. One of the first localizations affected with deficits of proteins, essential fatty acids, vitamins, electrolytes and minerals is the skin. Dermatologic symptoms result from malnutrition, recurrent vomiting, abuse of laxatives and/or diuretics or psychiatric disorders. The diagnostic criteria of specific (anorexia nervosa and bulimia nervosa) and non specific eating disorders are presented in the study, and the most common skin lesions (based on literature review) in children and adolescents with eating disorders are discussed. Attention is paid also to the etiopathogenesis of skin manifestations in these patients.
Eating disorders are common diseases, which can be difficult to manage. Anorexia has become an epidemic in Europe, particularly among young women. This disorder is associated with significant medical complications which affect all organs, including the skin. We present two cases of anorexia associated with a peculiar dermatological condition: hypercarotenaemia. Occasionally these patients develop early dermatological signs, which, if correctly interpreted, may provide useful clues for diagnosis and treatment, especially in occult or denied forms of the disease, and therefore improve prognosis.
Carotenoids are the colorful pigments abundant in fruits and vegetables that constitute an important part of the human diet. Decades of research on carotenoids has improved our understanding of the role of these ubiquitous pigments, which have emerged as important players in the fight against chronic and infectious diseases. This chapter describes the many facets of carotenoids including their occurrence and main dietary sources, the efficiency of absorption, and conversion to vitamin A. The role of conversion enzymes, the carotenoid oxygenases (BCMO1 and BCDO2), is explained, as well as the importance of carotenoid metabolites as bioactive compounds in the regulation of retinoid actions in the body. Their vital role as a source of vitamin A is reviewed in the context of increased need to prevent vitamin A deficiency in pregnancy and infancy, especially in developing countries. Specific functions in the macula and lens of the eye, in the corpus luteum of the ovary, and in skin are discussed. A description of the associations of plasma and dietary carotenoids with the risk of various acute and chronic diseases and conditions (cognitive decline, cancer, cardiovascular disease, diabetes, obesity, macular degeneration) is provided, along with explanations for possible mechanisms of action. Specifically, their antioxidant function in conditions of oxidative stress and inflammation is examined. The possibility of toxic effects for some carotenoids under certain circumstances is considered. Our knowledge of carotenoids continues to evolve with emerging scientific evidence, and a better understanding of these important plant pigments may improve human health and well-being worldwide.
Appearance-based interventions have had some success in reducing smoking and sun exposure. Appearance may also motivate dietary behavior change if it was established that dietary improvement had a positive impact on appearance. The aims of this review are to evaluate the current evidence examining the relationship between dietary intake and appearance and to determine the effectiveness of dietary interventions on perceived or actual appearance. An electronic search of English-language studies up to August 2012 was conducted using Cochrane, MEDLINE, Embase, CINAHL, Web of Science, SCOPUS, and PsycINFO databases. Studies that included participants aged at least 18 years, that observed or altered dietary intake from actual food or dietary supplement use, and assessed appearance-related outcomes were considered eligible. Data from 27 studies were extracted and assessed for quality using standardized tools. Nineteen studies were assessed as being of "positive" and 4 of "neutral" quality. All observational studies (n = 4741 participants) indicated that there was a significant association between various aspects of dietary intake and skin coloration and skin aging. The majority (16 studies, 769 participants) evaluated the effect of dietary supplements on skin appearance among women. Only 1 study examined the effect of actual food intake on appearance. Significant improvements in at least 1 actual or perceived appearance-related outcome (facial wrinkling, skin elasticity, roughness, and skin color) following dietary intervention were shown as a result of supplementation. Further studies are needed in representative populations that examine actual food intake on appearance, using validated tools in well-designed high-quality randomized control trials.
Copyright © 2015 Elsevier Inc. All rights reserved.
Laws, regulations and medical management for the underage
adolescent
Summary
The practice of the Adolescence Medicine implies - on the part of the sector’s sanitary operators – the at least generically knowledge of the most important rules and regulations which, in the different eventualities, guarantee the underages’ interests, with particular reference to the health’s protection in full obedience to the principles of privacy and confidentiality. It is at the same time indispensable to identify limits, rights and duties of the practitioner while giving
assistance to the underage adolescents, respecting their perspective autonomy without, however, losing sight of the personal,
legal, deontological and professional responsibility. Following these introductions, a synthetic reassessment of the most recent international regulations about the protection of the fundamental rights of underages is presented. As far as the Italian legislation is concerned, the articles of the Constitutional Chart directly or indirectly referred to the legal rights of underages are then reminded and commented. In the order of the Italian civil regulations, though it is recognized that the individual’s full mental capability is achieved only with the conclusion of the eighteenth year of age and the overcoming
of the minority, a succession of references are yet remarked, related to the importance – in certain situations – of the will also expressed by underages. Even if in the order of the Penal Law individuals younger than 14 are never indictable, it is known that individuals between 14 and 18 years old can be considered indictable if it is demonstrate, case by case, the achievement of the mental capacity. One of the issues that mostly involve the adolescent practitioner is certainly
represented by the regulation about the sexual assault and about the validity of the possible consent to the same sexual act given by an underage adolescent. The well known Law 194 about “Rules for the social protection of the maternity and for the pregnancy’s voluntary interruption” provides, in its turn, important ideas of knowledge and discussion.
There are finally some debates the issue, as of today still unsettled and controversial, relating to the validity of the informed
consent/assent/disagreement expressible by underage patients, relating to the right to the respect of the professional secret independently from the age, and to the right of the individual to know his/her own real clinical conditions and prognosis even if fatal. In the end is reminded the recent authority called “Ombudsman for Children and Adolescents” that, though it has been already established in the Scandinavian Countries since a long time, is actually present in more than 80 nations all around the world and identified in quite 17 Italian Regions.
Key words: adolescence, underage adolescents, legal rights, health protection.
Gli integratori alimentari, parte integrante della cosmetologia dagli anni Novanta, sono oggi in piena evoluzione. Le loro indicazioni derivano dalle proprietà evidenziate in vitro e nell’animale. Nell’uomo fino ad oggi sono stati realizzati pochi studi in vivo. Questo si può spiegare con la mancanza di regolamentazione della cosmetologia attiva. Gli integratori alimentari sono essenzialmente di quattro tipi: oligoelementi, vitamine, aminoacidi e acidi grassi essenziali. Le loro principali indicazioni sono l’invecchiamento cutaneo, la fotoprotezione, la prevenzione dei tumori, la caduta dei capelli, la fragilità ungueale e l’idratazione della pelle.
Normal functioning of the human body requires a balance between nutritional intake and metabolism, and imbalances manifest as nutritional deficiencies or excess. Nutritional deficiency states are associated with social factors (war, poverty, famine, and food fads), medical illnesses with malabsorption (such as Crohn disease, cystic fibrosis, and after bariatric surgery), psychiatric illnesses (eating disorders, autism, alcoholism), and medications. Nutritional excess states result from inadvertent or intentional excessive intake. Cutaneous manifestations of nutritional imbalance can herald other systemic manifestations. This contribution discusses nutritional deficiency and excess syndromes with cutaneous manifestations of particular interest to clinical dermatologists.
Carotenemia is characterized by an abnormal yellowish orange pigmentation of the skin, predominantly seen on the palms and soles. Although it may be associated with several diseases such as diabetes, hypothyroidism and anorexia nervosa, it is caused by excessive intake of carotene-rich food such as oranges and carrots in most cases. The condition is harmless, but it can lead to a mistaken diagnosis of jaundice. Herein, an interesting case of carotenemia is described in a 32-year-old female secondary to increased ingestion of oral sweet potatoes and oranges.
A case of carotinaemia in a patient with excessive beta-carotene food-intake, diabetes mellitus and physiological amenorrhea is reported. The patient developed yellow discolouration in the palms and the soles of her feet. Blood samples showed a significantly increased lever of serum beta-carotene, but normal vitamine A value and liver enzymes. The patient reported an excessive intake of carrots (approximately 1 kg per day). The status of physiological amenorrhoea and dysregulated diabetes mellitus may have deteriorated the yellow discolouration of the skin.
"Xanthoderma" is a term that describes a yellow to orange macular discoloration of the skin. The cause of this finding ranges from benign to potentially life-threatening disease. To date the literature fails to comprehensively review the various causes and workup of this clinical manifestation. This article discusses the etiopathogenesis of xanthoderma and suggests a novel diagnostic algorithm for the clinician to use in the initial evaluation of this condition.
To report a rare adult case of lycopenaemia associated with ingestion of excessive amounts of kaki fruit.
We describe the clinical manifestation and laboratory findings in our patient and the possible causes that induce this cutaneous disease.
A 68-year-old Caucasian woman presented with red-orange tinged skin of the palms and soles. Her diet included about 1 kg of kaki fruit daily. High-performance liquid chromatography showed increased lycopene levels.
Our case of lycopenaemia is a benign condition, secondary to an excessive dietary intake of lycopene-rich fruits. The discoloration of the palms and soles resulted from pigment deposits, due to the slow conversion of carotene to vitamin A. This condition disappeared after changes in her dietary habits.
Three cases are described of abnormal skin pigmentation due to carotenaemia arising from a presumed inborn error of carotene metabolism.
About a year ago one of us (A. F. H.) observed that two children in a ward containing about twenty-five infants, from a year to a year and a half in age, were developing a yellowish complexion. This coloration was not confined to the face, but involved, to a less extent, the entire body, being most evident on the palms of the hands, which showed also distinct signs of desquamation. The sclerotics were not at all affected. The urine was amber, and the stools normally yellow. For a time, we were at a loss to account for this peculiar phenomenon, when our attention was directed to the fact that these two children, and only these two, were receiving a daily ration of carrots in addition to their milk and cereal. For some time we had been testing the food value of dehydrated vegetables, and when the change in color was
Carotenodermia occurs in individuals in a college-aged population who exhibit signs of anorexia and/or bulimia nervosa. It is caused by consuming large amounts of raw carrots. In the same population, athletes are at risk for hypervitaminosis A because of injudicious self-administration of high-potency vitamin preparations.
We evaluated the relation between plasma levels of carotenoids and carotenodermia in 30 men receiving carotenoid supplementation for 42 d. Five subjects each were randomly assigned to one of six treatment groups: 30 mg purified beta-carotene supplement, 12 mg beta-carotene supplement, 272 g cooked carrots, 300 g cooked broccoli, 180 g tomato juice, and placebo. Definite carotenodermia was observed only in the five subjects who took 30 mg of purified beta-carotene daily. Carotenodermia was first noted between 25 and 42 d after supplementation and persisted from 14 to greater than 42 d posttreatment and was observed only after plasma total carotenoid levels exceeded 4.0 mg/L. These observations may be useful to investigators planning clinical trials with beta-carotene and to clinicians assessing the significance of carotenodermia in men taking beta-carotene supplements or following diets high in carotenoid-containing foods.
Three cases are described of abnormal skin pigmentation due to carotenaemia arising from a presumed inborn error of carotene metabolism.
Carotenodermia may arise from excessive dietary intake of carotene containing foods. We reported a 22-year-old woman who had eaten excessive amount of carotene-rich seaweed to lose weight. Her skin color changed to orange-yellow, and her serum beta-carotene was 573 micrograms/dl. After stopping the ingestion of seaweed, her skin color returned to normal.
There is increasing evidence that the macular pigment carotenoids, lutein and zeaxanthin, may play an important role in the prevention of age-related macular degeneration, cataract, and other blinding disorders. Although it is well known that the retina and lens are enriched in these carotenoids, relatively little is known about carotenoid levels in the uveal tract and in other ocular tissues. Also, the oxidative metabolism and physiological functions of the ocular carotenoids are not fully understood. Thus, we have set out to identify and quantify the complete spectrum of dietary carotenoids and their oxidative metabolites in a systematic manner in all tissues of the human eye in order to gain better insight into their ocular physiology.
Carotenemia is a condition characterized by yellow discoloration of the skin and elevated blood carotene levels. Excessive and prolonged ingestion of carotene-rich, yellow- or orange-colored foods such as carrots and winter squash is the most common cause, but more rarely it may be associated with consumption of other foods as well as with hypothyroidism, diabetes mellitus, anorexia nervosa, liver disease, or kidney disease. Though not uncommon in children, there are few reports in the pediatric literature since its early descriptions in the late 1800s and early 1900s. Awareness of carotenemia can help the provider resolve confusion with jaundice and avoid unnecessary worry and costly tests. Herein we describe carotenemia in an 8-month-old Caucasian girl secondary to increased consumption of commercial infant food green beans.