What is Jaundice?
Jaundice is the yellowing of your skin and the whites of your eyes caused by too much yellow pigment called bilirubin, produced when haemoglobin, the main component of red blood cells, is broken down. When it is released from red blood cells into the bloodstream, bilirubin is taken to the liver, where it is further modified and passed to the small intestines via bile ducts. From there, it’s excreted from the body through urine or stool. However, if the flow out of the system is disrupted, bilirubin can accumulate in the body [1].
What Are The Causes of Jaundice?
Jaundice can result from a variety of conditions, several of which involve the liver. A common factor is the overproduction of bilirubin or the liver's inability to handle it. For instance, when there’s a block in the bile ducts through which it usually leaves the body, the bilirubin has nowhere to go and instead builds up in the blood [2].
Other conditions that can result in jaundice include alcohol abuse, liver cancer, thalassaemia, cirrhosis (scarred liver, often due to alcohol), gallstones, hepatitis A, B, C, D and E, pancreatic cancer, G6PD deficiency, biliary (bile duct) obstruction, sickle cell anaemia, acute pancreatitis and other blood disorders such as haemolytic anaemia. An adverse reaction to, or overdose of, drugs such as acetaminophen (Tylenol) can cause jaundice too [2].
Among newborns, jaundice is common, especially for those born premature, because the liver hasn’t had a chance to develop fully and can produce more bilirubin than the body can eliminate, a phenomenon called breast milk jaundice [2].
Risk Factors of Jaundice
Jaundice, a condition characterized by yellowing skin and eyes, can be caused by various factors.
The main risk factor is liver disease, including cirrhosis, viral hepatitis, primary biliary cirrhosis, alcoholic hepatitis and liver cancer. This disease can damage the liver and blunt its ability to filter blood and remove bilirubin, a yellow compound that causes jaundice if it builds up in the blood [1].
Some of these genetic diseases also raise the chance of jaundice. G6PD deficiency is when red blood cells break down prematurely, causing bilirubin to accumulate. This condition is exceedingly common in some populations, including roughly one in 10 African American males in the United States [3].
Maternal factors that can increase the risk of neonatal jaundice include white blood cell count, haemoglobin levels, platelet count and gestational age of the mother, as well as thyroid-stimulating hormone (TSH), level of T4 in neonate and G6PD deficiency [4]. Other maternal risk factors include hypertension, diabetes, type of delivery, vaginal bleeding, premature rupture of membranes (PROM), maternal age and incorrect technique of breastfeeding [5].
Lifestyle factors that can add to these risk factors for jaundice are excessive alcohol consumption and certain medications such as acetaminophen, certain cardiac medications, antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), statins, dietary supplements and anabolic steroids [1, 3].
Additionally, jaundice can be caused by conditions such as nonalcoholic fatty liver disease (NAFLD), hepatitis, sickle cell anaemia and gallstones, which disproportionately affect certain groups of people due to genetic, social and environmental factors. For example, African Americans have higher rates of jaundice caused by these conditions [3].
Does Jaundice Affect Different Races?
Although jaundice, or yellow skin and eyes because of high bilirubin, occurs in all racial groups, the risk factors and incidence for jaundice can differ among racial and ethnic groups depending on genetic influences, environmental factors and social backgrounds.
Certain conditions among African Americans (black individuals) that can cause jaundice are much more prevalent – the age-adjusted chronic hepatitis rate for African Americans is 31%, compared with 11% for whites; the age-adjusted hepatitis C infection rate for African Americans is 23%, compared with 12% for whites [3]. Sickle cell anaemia, which can cause a buildup of bilirubin and jaundice, is found almost exclusively in African populations (98% of US sufferers are African American) [3].
Conversely, East Asian and Southeast Asian newborns showed an increased risk for neonatal jaundice versus white infants, with infants of full East Asian descent having a 37% greater risk of being diagnosed with jaundice than white infants [6].
However, the diagnosis of jaundice can be more difficult in those with darker skin. The yellowing of the skin might not be as obvious, and there could be a delay in diagnosis [3, 7].
What Does Jaundice Look Like in Black People?
Jaundice is a condition in which the skin and eyes appear yellow due to excess bilirubin, a yellow pigment, in the blood. Because bilirubin is naturally present in the body, Black individuals can have normal bilirubin levels that are still high enough to make their skin appear visibly yellow to the eye. Especially when skin is more intensely pigmented, the yellowing of the skin is more difficult to detect [3].
In Black people, the yellowing of the whites of the eyes (the sclera) is often more conspicuous than the yellowing of the skin. Yellowing of the eye whites is a symptom of jaundice, but other abiotic, innocuous causes have to be considered in dark-skinned people [3].
Other possible signs and symptoms include right upper quadrant abdominal pain, fatigue, lightheadedness, confusion, fever, anorexia, nausea, vomiting, pruritus, brownish or dark urine, and clay-coloured or pale stools. Symptoms depend on age and the underlying cause of jaundice [3].
Because jaundice can be more challenging to spot in darker-skinned patients, the skin becomes a vital tool. Ideally, sclera and palm exams are performed carefully, as yellowing is most evident in these areas. Meanwhile, questioning any possible changes in the patient’s skin colour can be helpful [7].
Jaundice is common in infants, mainly because their livers may not be fully developed to remove bilirubin from the blood adequately. Dark-skinned babies can have harder-to-detect jaundice. You can gauge this by looking for discolouration in the gums and top of the lips. Pressing gently on the skin with your thumb can also help detect yellowing [3].