What is jaundice (icterus) and when is it apparent in the skin?

On average, 250 to 350 mg of bilirubin is normally generated daily, with 70% to 80% arising from senescent red blood cells and the remainder coming from heme proteins in the bone marrow and liver. Jaundice is the overaccumulation of bilirubin and various bile pigments in the skin and other organs. It is first seen in the sclera of the eye, skin (especially the face), and hard palate. Jaundice may result from stone obstruction, hemolysis with overproduction of bilirubin, ineffective erythropoiesis, or intrinsic liver disease. Jaundice is best seen in bright daylight and may be overlooked indoors. Jaundice is not clinically apparent until serum bilirubin exceeds 2.0 to 2.5 mg/dL in the adult and 5 mg/dL in the neonate. Jaundice may be the first and sole sign of hepatic dysfunction.

Kliegman R, Nelson WE: Nelson textbook of pediatrics. ed 18. Philadelphia, 2007, Saunders Elsevier.