Causes and Risk Factors of Yellow Skin

Yellowish skin is usually caused by jaundice. This condition happens when there is a high level of bilirubin in the blood. Jaundice can be a sign of a serious condition, such as liver disease.

Bilirubin is a yellowish compound formed when old or damaged red blood cells break down. The accumulation of bilirubin is also known as hyperbilirubinemia and causes yellowing of the skin, whites of the eyes, and mucus membranes. 

What Does Jaundice Look Like?

People with jaundice have yellowish skin, though this will be more apparent in someone with a lighter skin tone. People with darker skin may only notice yellowing in the whites of the eyes and the mucous membranes.

People with lower levels of bilirubin may look slightly yellow, and the color change may only be noticeable in certain light. People with higher levels of bilirubin may have bright yellow skin accompanied by itching.

Eating a lot of foods that contain beta-carotene may also cause a slight yellowing of the skin. This can be distinguished from jaundice because it does not also cause yellowing of the eyes.

What Causes Jaundice?

Jaundice occurs when the body is unable to process the resulting bilirubin from red blood cells that broke down. Usually, bilirubin is taken by the bloodstream to the liver, where it binds with bile and flows through the bile ducts to the digestive tract to be eliminated.

Bilirubin is usually removed from the body through stools, and a small amount is eliminated via urine. When there is a problem with this process, bilirubin builds up in the blood and is deposited in the skin. Because bilirubin has a brownish-yellow color, a high level of it causes the skin to appear yellow.

There are several possible causes of jaundice, and your healthcare provider can help you determine what is causing your yellow skin. 

Hepatitis 

Hepatitis (inflammation of the liver) causes damage to the liver, preventing it from efficiently removing bilirubin from the bloodstream.

Hepatitis can be caused by viruses and non-viral causes. Hepatitis A is a foodborne illness that causes food poisoning and usually resolves on its own. Hepatitis B and hepatitis C are viruses transmitted through blood and body fluids. Without treatment, these conditions can lead to long-term liver damage. 

Obstruction of the Bile Duct

Once bilirubin binds with bile, it should flow through your body’s bile ducts to the pancreas, then to the small intestine to be excreted. However, if the bile duct is blocked, bilirubin won’t be eliminated and can build up, leading to jaundice.

A common cause of an obstructed bile duct is gallstones. Gallstones, also known as cholelithiasis, are formed when bile from the liver hardens. This can be a result of bile that contains too much cholesterol or bilirubin. Gallstones can also be caused by improper gallbladder emptying. When gallstones form, they can get caught in the bile duct and lead to hyperbilirubinemia. 

Rarely, serious conditions such as cancer of the pancreas or bile duct can also lead to bile duct blockage. 

Medication Side Effects 

Certain medications, especially if taken more than prescribed, can lead to liver damage that results in jaundice. The most common medications that can cause jaundice include:

• Acetaminophen (Tylenol)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen 
• Amiodarone
• Isoniazid
• Anabolic steroids
• Amoxicillin-clavulanate

Jaundice in Newborn Babies

The most common cause of yellow skin in newborns is physiologic jaundice. Almost all newborns experience some degree of this type of jaundice in their first few days. This is because newborns have a faster rate of red blood cell breakdown, leading to an elevated level of bilirubin in the blood. They also have immature livers that can’t process all of that extra bilirubin yet. Physiologic jaundice in newborns usually resolves after a week and doesn't require treatment. 

Some newborns also experience breastfeeding jaundice, also known as suboptimal intake jaundice, which happens when they are not receiving enough breastmilk. When a mother’s milk has not yet come in, the newborn will get fewer nutrients and thus have fewer bowel movements. This can lead to increased reabsorption of bilirubin in the intestines and lead to a buildup.

Genetics

Rare genetic conditions can cause hyperbilirubinemia, also called bilirubin metabolic disorder, and yellow skin.

Gilbert Syndrome

Gilbert syndrome is caused by changes in the UGT1A1 gene and affects about 3% to 7% of Americans. It is a condition that causes increased amounts of bilirubin in the blood. The increased levels of bilirubin in this condition are usually mild and do not lead to jaundice. Most cases are diagnosed in adolescence, and many people with Gilbert syndrome never show any symptoms. The increased bilirubin level can occur during times of physical stress like fasting or strenuous exercise. 

Crigler-Najjar Syndrome

Crigler-Najjar syndrome, also known as hereditary unconjugated hyperbilirubinemia, is much more serious and less common than Gilbert syndrome. It is caused by mutations in the UGT1A1 gene and affects fewer than 1 in 1 million babies born worldwide. This syndrome is characterized by dangerously high levels of bilirubin in the blood.

Crigler-Najjar syndrome is divided into two types. Type 1 is the most severe and can lead to kernicterus, a life-threatening condition that occurs when a toxic amount of bilirubin collects in the brain. Type 2 is less severe, and affected individuals are less likely to develop kernicterus.

Cardiovascular

Hyperbilirubinemia can also be connected to heart disease. A 2011 study found that people with congenital heart disease (CHD) had a significantly higher risk of developing gallstones. This puts individuals with CHD at higher risk of developing jaundice if the gallstones become lodged in the bile duct and obstruct the flow and elimination of bilirubin.

Lifestyle Risk Factors

Alcohol can cause liver damage, leading to hyperbilirubinemia. Jaundice may be a sign of pancreatitis, an inflammation of the pancreas. This is most often caused by gallstones or alcohol use. Alcohol is also one of the most common causes of hepatitis. 

Alcohol use can affect how our bodies secrete and excrete bile and lead to gallstones, fatty liver disease, and cirrhosis. Fatty liver disease is characterized by fat deposits on the liver, and can be caused by alcohol or obesity. Cirrhosis refers to scarring on the liver caused by chronic damage, which can result from chronic alcohol use. 

Summary

Yellow skin is often a sign of a condition, and many of the causes can be reversed with medication or treatment. In newborns, yellowing of the skin is often temporary and not a cause for concern. Talk with your healthcare provider about when you first noticed yellowing in your skin and eyes to find out what the underlying condition is and develop a treatment plan accordingly.