YELLOW HANDS: CAUSES AND TREATMENT - MEDICINE - 2024

The yellow hands are not a disease in itself, but a symptom of an underlying responsible for the color change in the hands and other parts of the body condition. The color change in the hands (they turn yellowish on the palms and then on the back) is usually accompanied by a similar change in the sclera of the eye (the white part).

Together, they are the earliest clinical signs that something is wrong with the body. It may be something benign or a more serious condition that requires specialized medical intervention; hence the importance of an adequate clinical diagnosis, because a wrong approach can have serious consequences for the patient.

Causes

The causes of yellow hands can be divided into two large groups:

- Excess consumption of beta carotenes.

- jaundice

These are the two main causes of this clinical sign, although cases of anemia with yellow palms of the hands (generally hemolytic anemias) have also been described.

However, most of the time anemia presents with palms that are paler than normal due to the decrease in hemoglobin levels.

Likewise, it is important to remember that in cases of hemolytic anemia, the yellow color of the hands and scleras is due to the jaundice that occurs in this type of anemia.

Beta carotene excess

Beta-carotene is a chemical compound present in abundance in yellow foods, such as carrots, squash (squash in certain countries), arracha (celery in some countries) and, to a lesser extent, in dairy products such as butter and some cheeses.

It is considered a pro-vitamin since, once it is consumed by humans, it becomes Vitamin A, essential among other things for visual health.

It is a fat-soluble compound that is metabolized in the liver, where it is also stored; however, when the liver's storage capacity becomes saturated, there is the possibility of storing beta-carotene in adipose tissue (body fat).

When this occurs the adipose tissue turns yellowish, which can be visible in areas of the body where the skin is thinner allowing the color of the underlying fat to be visible through transparency.

This is especially true in the palms of the hands, due to the combination of a relatively thick fat pad (particularly in the thenar and hypothenar regions) covered by a relatively thin layer of skin.

Excess beta-carotene (hyperbeta-carotidemia) does not represent any type of health risk or is a reflection of any pathological condition; however, it is necessary to establish a differential diagnosis with jaundice since the latter is usually associated with much more delicate diseases.

Jaundice

Jaundice is defined as the yellowish tint of the skin and mucous membranes due to the increase in bilirubin. At first this coloration is more evident on the palms of the hand and the sclera of the eyes, although as it evolves it spreads to all cutaneous and mucosal surfaces (including the oral mucosa).

In these cases, the yellow color is due to the elevation of blood levels and subsequent accumulation in the tissues of a pigment known as bilirubin, which is produced in the liver as part of the metabolism of the Hem group, being excreted through the bile into the digestive tract from where one part is reabsorbed and another is expelled with the feces.

Bilirubin can be of two types: direct (when it is conjugated with glucuronic acid) and indirect (it has not been conjugated with glucuronic acid and is therefore bound to albumin).

Indirect bilirubin is that which has not been processed by the liver; that is, it is the fraction of bilirubin that has not yet been prepared for expulsion. In the liver this molecule is conjugated with glucuronic acid to be expelled as part of the bile.

In itself, hyperbilirubinemia (technical name given to elevated levels of bilirubin in the blood) is not a disease, but rather the consequence of an underlying problem.

Causes of hyperbilirubinemia and jaundice

The causes of hyperbilirubinemia and its clinical manifestation, jaundice, are many and varied. For this reason, it is very important to establish a differential diagnosis in order to initiate the appropriate treatment.

In this sense, hyperbilirubinemia can be of two types: at the expense of indirect bilirubin and as a consequence of the elevation of direct bilirubin levels.

Indirect hyperbilirubinemia

It occurs when unconjugated bilirubin levels in the blood rise. This is due either to an increase in the production of bilirubin, which exceeds the processing capacity of the liver, or to a blockage of the conjugation systems in hepatocytes, either due to biochemical alterations or loss of cell mass.

In the first case (increased bilirubin production), the most common is that there is an increase in the destruction of red blood cells beyond normal, generating an amount of substrate (Hem group) that exceeds the processing capacity of the liver, ultimately leading to elevation of indirect bilirubin in the blood.

This is common in cases of hemolytic anemia as well as in hypersplenism, where red blood cells are destroyed at a higher rate than normal. In these cases we speak of prehepatic jaundice.

On the other hand, there are cases of liver jaundice in which the amount of substrate is normal, but the liver's processing capacity is decreased.

This decrease in processing capacity may be due to biochemical alterations in the hepatocyte (functional cell of the liver), such as occurs in certain genetic diseases or as a result of certain drugs that block the metabolic pathways of bilirubin.

The decrease can also occur as a consequence of viral infections of the hepatitis type, where there is destruction by the T lymphocytes of the hepatocytes infected by the virus.

On the other hand, when liver cells are lost - as occurs in cirrhosis and liver cancer (both primary and metastatic) - the number of cells available to metabolize bilirubin decreases and, therefore, their levels rise.

In these cases, an elevation of the unconjugated fraction of bilirubin is detected, since it accumulates in the blood before it has been glucuronized in the liver.

Direct hyperbilirubinemia

In these cases, we speak of posthepatic jaundice and it is due to the accumulation of bilirubin conjugated with glucuronic acid, which cannot be excreted in a normal way.

When this occurs, it is called biliary obstruction or cholestasis, which can occur at any point, from the microscopic bile canaliculi in the liver to the main bile duct or common bile duct.

In cases where direct hyperbilirubinemia occurs due to microscopic obstruction, it is referred to as intrahepatic cholestasis.

In general, intrahepatic cholestasis is due to genetic diseases that produce sclerosis (closure) of the bile canaliculi, making it impossible for conjugated bilirubin to be excreted into the bile, so it is absorbed back into the circulation.

If the obstruction occurs beyond the canaliculi, in some of the larger bile ducts we speak of obstructive jaundice, the most frequent cause of this being the presence of gallstones (stones) that block the bile duct.

Stones are the most common cause of obstructive jaundice, but there are other medical conditions that can lead to obstruction of the main bile duct.

These conditions can obstruct the pathway either by extrinsic compression (as in pancreatic cancer) or sclerosis of the bile ducts (as in bile duct cancer -cholangiocarcinoma- and bile duct atresia).

When a patient has obstructive jaundice, it is usually accompanied by acholia (pale, very white stools, reminiscent of wet lime) and coluria (very dark urine, similar to a highly concentrated tea).

The triad of jaundice-coluria-acholia is an unequivocal sign of biliary obstruction; the challenge is to identify the exact place.

In all cases of jaundice, a detailed diagnostic approach is essential to identify the cause and thus initiate appropriate treatment.

Treatment of yellow hands

In cases of yellow palms due to hyperbetacarotidemia, it is enough to limit the consumption of foods rich in beta carotene so that the color gradually fades.

On the other hand, in cases of jaundice there is no specific treatment; in other words, there is no therapeutic strategy aimed exclusively at lowering bilirubin levels in the blood.

Instead, the cause of hyperbilirubinemia should be addressed, since by doing so the bilirubin levels in the blood will progressively return to normal.

The therapeutic strategies are multiple and very varied depending on the cause, but in general they can be summarized into four large groups:

- Pharmacological or surgical treatments that avoid the excessive destruction of red blood cells.

- Invasive treatments (surgical or endoscopic) aimed at relieving the obstruction of the bile ducts.

- Liver transplantation to replace a liver badly damaged by cirrhosis, which can no longer function normally.

- Palliative oncological treatments to try to reduce the damage caused by liver metastases. In these cases the prognosis is ominous, since it is a terminal disease.

It is more than evident that yellow hands are a clinical sign that should not be underestimated, since it is usually associated with quite delicate nosological entities.

For this reason, when this symptom appears, the best idea is to consult a specialist as soon as possible, in order to identify and treat the cause of the problem before it is too late.

References

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