Correspondence

Hypercarotenemia

N Engl J Med 2002; 347:222-223July 18, 2002

Article

To the Editor:

Mazzone and Dal Canton describe a case of hypercarotenemia in a young woman (March 14 issue).1 If a young female patient presents with hypercarotenemia, anorexia nervosa should be considered.2 A history of a low-calorie diet composed of vegetables, as in the case described by the authors, should increase the suspicion that the patient may have anorexia nervosa. Children metabolize carotene more slowly than adults, and this slower rate of metabolism can result in hypercarotenemia in children who ingest carotenoids. Hypercarotenemia, especially when present in girls or young women, can be an important clue to the diagnosis of anorexia nervosa. This finding may increase the clinical suspicion of anorexia nervosa when it is occult, may help motivate a patient with anorexia nervosa to accept treatment because there is a tangible sign of “disease,” and may help rule out malabsorption in a patient with substantial weight loss.

Carl L. Birmingham, M.D., M.H.Sc.
University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
clbirm@interchange.ubc.ca

2 References

1. 1

   Mazzone A, Dal Canton A. Hypercarotenemia. N Engl J Med 2002;346:821-821
   Full Text | Web of Science | Medline

2. 2

   Walsh BT. Eating disorders. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison's principles of internal medicine. 15th ed. Vol. 1. New York: McGraw-Hill, 2001:486-90.
   

To the Editor:

Although the photograph of the hand of a woman with hypercarotenemia is impressive, there is a slight but important mistake in the information provided by the authors. Porphyria is not the cause of hypercarotenemia, but oral administration of beta carotene is often successful for the treatment of sun sensitivity in patients with erythropoietic protoporphyria.

Claus A. Pierach, M.D.
Abbott Northwestern Hospital, Minneapolis, MN 55407
claus.a.pierach-2@tc.umn.edu

Author/Editor Response

The authors reply:

To the Editor: In most cases, as in the one we describe and illustrate, carotenemia depends on excessive intake of carotenoid-rich food. This often occurs as part of an alimentary disorder, which may range from overconsumption of artificially colored, commercially available products1 to anorexia nervosa. In fact, patients with anorexia nervosa usually consume a purely or predominantly vegetarian diet.2 In a minority of patients, carotenemia is associated with organic diseases, including erythropoietic protoporphyria. Though the disordered metabolism of porphyrin is not causally related to carotenemia, the dose of beta carotene used to prevent photosensitivity (50 to 200 mg daily)3 often leads to discoloration of the skin.

Antonino Mazzone, M.D.
Antonio Dal Canton, M.D.
University Policlinico San Matteo, 27100 Pavia, Italy
medicina2legnano@ao-legnano.it

3 References

1. 1

   Bonnetblanc JM, Bonafe JL, Vidal E. Carotenodermies dietetiques. Ann Dermatol Venereol 1987;114:1093-1096
   Web of Science | Medline

2. 2

   Kemmann F, Pasquale SA, Skaf R. Amenorrhea associated with carotenemia. JAMA 1983;249:926-929
   CrossRef | Web of Science | Medline

3. 3

   Thomsen K, Schmidt H, Fischer A. Beta-carotene in erythropoietic protoporphyria: 5 years' experience. Dermatologica 1979;159:82-86
   CrossRef | Medline

Citing Articles (1)

Citing Articles

1. 1

   (2002) Chronic Urticaria and Angioedema. New England Journal of Medicine 347:21, 1724-1724
   Full Text