What can a jaundice color spectrum tell me about the types of liver disease in a patient?

Yellow discoloration of the skin is caused by bilirubin, while orange shades come from xanthorubin (intrahepatic jaundice). A deep green skin color is due to marked biliverdinemia and is characteristic of obstructive jaundice, as seen with pancreatic cancer. Patients with hepatobiliary disease, especially obstructive jaundice, often have severe pruritis; constant scratching results in inflammation of the skin follow by postinflammatory hyperpigmentation. The combination of postinflammatory hyperpigmentation and bile pigments imparts a bronze color to the skin. “Bronzing” is also encountered in hemochromatosis and primary Addison’s disease.

Do not forget about exogenous plant pigments, metabolic diseases, and trematode ingestion when examining a patient who appears jaundiced. The differential diagnosis of jaundice includes carotenemia (excessive ingestion of carotenoids), lycopenia (via tomato juice), Clonorchis sinensis (travel to Asia) or Fasciola hepatica (ingesting watercress) infection, and the sallow skin of myxedema