Yellow Palms and Soles in Diabetes Mellitus

Jiun-Nong Lin, M.D.
N Engl J Med 2006; 355:1486

A 55-year-old man presented with a 1-month history of yellow discoloration of his palms and soles (arrow, right palm, as compared with a normal palm to the left). Diabetes mellitus had been diagnosed 1 month before admission. His conjunctiva were not icteric. The fasting glucose level was 293 mg per deciliter (16.2 mmol per liter), and the glycated hemoglobin value was 12.8%. The serum bilirubin and free thyroxine levels were within normal limits. He did not report ingesting excessive amounts of carotene-rich fruits or vegetables, such as carrots, squash, and green beans. Yellow discoloration of the skin may be associated with carotenemia, hypothyroidism, diabetes mellitus, liver disease, and renal disease. It is an uncommon finding in patients with diabetes. Traditionally, it is considered to be related to carotenemia, but it may also be associated with end products of advanced glycation. This patient was treated with oral hypoglycemic medication, his glycated hemoglobin value was 7.0% at 1 year, and the yellow discoloration of his palms and soles has improved.

Jiun-Nong Lin, M.D.
Paochien Hospital, Pingtung 900, Taiwan
jiunong.lin@msa.hinet.net