Causes of Jaundice Yellow Skin

The sudden yellowing of the skin is usually a sign of jaundice, a condition caused when a brownish-yellow pigment called bilirubin builds up in your blood.

Bilirubin, the byproduct of the breakdown of red blood cells, usually passes through the liver to be excreted in stool (poop). If you have liver disease, this doesn't happen and bilirubin can start to accumulate, leading to the yellowing of the skin and sclera (whites of the eyes). 

Although liver disease is one of the primary causes of jaundice, there are other possible explanations such as gallstones, medication side effects, genetic disorders, and even heart disease.

This article describes possible causes and risk factors of jaundice, as well as a few conditions easily mistaken for jaundice.

What Does Jaundice Look Like?

Jaundice, also known as icterus, is the temporary yellowing of the skin and sclera caused by high bilirubin levels (referred to as hyperbilirubinemia).

The severity of jaundice can vary by the disease as well as your skin tone. If the underlying disease is relatively mild, it may only cause mild skin discoloration. Severe cases can cause your eyes, skin, and mucous membranes to turn a bright yellow, often accompanied by symptoms like fatigue, upper abdominal pain, and pale stools.

In people with light skin tones, the discoloration may be more apparent than those with dark skin tones. If you have very dark skin, the only notable change may be in the whites of your eyes.

Common Causes

Jaundice is a symptom of a disease that affects either the liver, the biliary tract (the system linking the liver, gallbladder, pancreas, and small intestine), or the normal breakdown of red blood cells. When this happens, bilirubin levels can increase either because it is not being excreted as it should or too much bilirubin is being produced. Sometimes a combination of factors is involved.

The causes of jaundice are typically classified as:

• Prehepatic (occurring before the liver): Red blood cells are being broken down at an abnormally fast rate, causing bilirubin levels to increase.
• Hepatic (occurring within the liver): Liver problems affect the uptake and excretion of bilirubin from the body, leading to elevated levels.
• Posthepatic (occurring after the liver): There is an obstruction in the biliary tract, causing bilirubin to accumulate and be absorbed by tissues.

There are several prehepatic, hepatic, and posthepatic conditions commonly associated with jaundice:

Hepatitis 

Hepatitis describes the inflammation of the liver by any number of causes. The inflammation can be acute (sudden and severe) or chronic (persistent and possibly lifelong). In either instance, the inflammation can affect the uptake and excretion of bilirubin, leading to jaundice.

Hepatitis can be caused by viral and non-viral causes. Viral causes are hepatitis A, hepatitis B, and hepatitis C. Non-viral causes include medications, alcohol, and autoimmune diseases.

Cirrhosis

Cirrhosis occurs when extensive scarring (fibrosis) of the liver reduces its ability to function. There are many causes of cirrhosis, including viral hepatitis, autoimmune hepatitis, excessive alcohol use, and the excessive buildup of fat in the liver.

Compensated cirrhosis occurs when the liver is damaged but is still functional. Decompensated cirrhosis is when the liver is no longer functional, resulting in jaundice and other severe symptoms.

Decompensated cirrhosis can lead to liver failure and increase the risk of liver cancer, both of which require a liver transplant to survive.

Neonatal Jaundice

Almost all newborns have some degree of jaundice in their first few days. This is because they 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 bilirubin as effectively.

Neonatal is relatively harmless. It usually resolves after a week and doesn't require treatment. 

Another potentially serious cause is Rh incompatibility. This is a condition that happens during pregnancy when a pregnant person has Rh-negative blood and their unborn baby has Rh-positive blood. The Rh factor is a specific protein found on the surface of red blood cells.

Because people with Rh-negative blood types are relatively uncommon, Rh incompatibility doesn't occur all that often (mostly in those with an O-positive blood type). If it does, the baby can be treated with a blood transfusion after birth along with phototherapy to help reduce the amount of bilirubin in the blood.

Medication Side Effects

Certain medications can lead to liver toxicity and inflammation if used in excess or taken with alcohol. In severe cases, jaundice can occur.

Some of the medications that can induce jaundice include:

• Tylenol (acetaminophen)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) 
• Pacerone (amiodarone)
• Isoniazid
• Anabolic steroids
• Augmentin (amoxicillin-clavulanate)

Biliary Obstruction

Once bilirubin leaves the liver, it binds with bile excreted by the gallbladder, passes through duct ducts connected to the pancreas, and is emptied into the small intestine to be excreted.

If any part of this route is blocked—most specifically the common bile duct—bilirubin won’t be eliminated from the body and can build up in the bloodstream.

A common cause of a biliary obstruction is gallstones (cholelithiasis) which form when bile from the liver hardens. Other causes of obstruction include biliary cysts, cholangitis (inflammation of the bile ducts), complications of gallbladder surgery, and bile duct cancer.

Pancreatic Disorders

The pancreas is connected to the gallbladder via the pancreatic duct which melds into the larger common bile duct. As part of the biliary system, the pancreas produces enzymes that help to digest food, particularly proteins.

Diseases affecting the pancreas can block the common bile duct and impair the normal flow of bilirubin to small intestines. These include pancreatitis (inflammation of the pancreas), benign tumors or cysts, and pancreatic cancer.

Fatty Liver Disease

Fatty liver disease is the excess buildup of fat in the liver which causes inflammation and fibrosis. There are two types:

• Alcoholic fatty liver disease (AFLD): Caused by the excessive consumption of alcohol
• Nonalcoholic fatty liver disease (NAFLD): Associated with obesity, diabetes, and high cholesterol

Symptoms can develop as the percentage of liver fat increases along with the area of liver damage. With NAFLD, this can lead to a severe condition called nonalcoholic steatohepatitis (NASH). As the injury progresses, symptoms of hepatitis can start to appear, including jaundice, abdominal swelling, intense itching, and spider veins.

Lifestyle Risk Factors

There are several lifestyle factors closely linked to liver inflammation and, in turn, jaundice:

• Alcohol overuse: The excessive intake of alcohol can cause liver injury, leading to hyperbilirubinemia. Alcohol is one of the most common, non-viral causes of hepatitis and can also contribute to gallstones, fatty liver disease, and cirrhosis.
• Vitamin A overuse: Most adults need about 1,000 to 2,000 international units (IU) of vitamin A per day. High doses of vitamin A (over 40,000 IU) can lead to liver inflammation and fibrosis, manifesting in jaundice.
  

Genetics

There are two rare genetic conditions that cause hyperbilirubinemia:

Gilbert Syndrome

Gilbert syndrome is a relatively harmless condition affecting 3% to 7% of people in the United States in which the liver doesn't properly process bilirubin. It causes increased levels of bilirubin but usually without jaundice. If jaundice occurs, it is most often seen in the eyes.

Most cases are diagnosed in adolescence, and many people with the disease never show any signs. The increased bilirubin levels often 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 affects fewer than 1 in one million babies born worldwide, causing dangerously high levels of bilirubin in the blood.

Crigler-Najjar syndrome occurs when bilirubin cannot be bound to a compound, called glucuronic acid, that helps it be excreted in stool. The bilirubin collects in the child’s liver and spleen and then builds up in other tissues such as the eyes and skin. The buildup can be so extreme as to cause nerve and brain damage.

Cardiovascular

On rare occasions, congestive heart failure can cause mild jaundice by contributing to a condition known as congestive hepatopathy. Because the two organs are connected by blood circulation, any change in circulation from the heart can affect the liver.

With congestive hepatopathy, the reduced blood flow to the liver compromises the flow of blood out of the liver, causing blood to back up and become congested within the organ. The congestion triggers inflammation that, in turn, affects the uptake and excretion of bilirubin from the liver, leading to mild jaundice and upper abdominal pain.

Yellowing Skin Not Due to Jaundice

There are certain conditions in which the yellowing of the skin is unrelated to jaundice and is neither caused by a liver nor biliary disease. These include:

• Carotenemia: This is a harmless condition that occurs when you eat too much carotene-rich food (like carrots, papaya, mango, apricots, or beets), leading to a temporary yellowish or orangish discoloration of the skin.
• Xanthelasma palpebrarum: This is a condition in which soft, yellow bumps or lesions filled with cholesterol form on the eyelids or around the eyes. The condition itself is harmless but is associated with potentially harmful ones like diabetes and high cholesterol.
  

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.