Eruptive Xanthomas
A 27-year-old man presented to the dermatology clinic with an asymptomatic rash on his back, arms, and hands that had developed 1 week earlier. He had a history of obesity and consumed a high-fat diet with frequent alcohol use. He had no known family history of dyslipidemia, vascular disease, or pancreatitis. On physical examination, scattered pink-yellow papules were present on the upper back, extensor surfaces of the upper arms (Panel A), and dorsa of the hands (Panel B). A fasting blood sample was grossly lipemic (Panel C). The triglyceride level was 10,650 mg per deciliter (120.2 mmol per liter; reference value, <151 mg per deciliter [<1.7 mmol per liter]), and the total cholesterol level was 1102 mg per deciliter (28.5 mmol per liter; reference value, <201 mg per deciliter [<5.2 mmol per liter]). A diagnosis of eruptive xanthomas due to severe hypertriglyceridemia was made. The differential diagnosis includes molluscum contagiosum, sebaceous hyperplasia, and generalized eruptive histiocytoma, but eruptive xanthomas should be suspected in patients with risk factors. The patient was referred to the internal medicine clinic for further evaluation and treatment. After 1 month of treatment with fenofibrate, along with alcohol cessation, exercise, and a low-fat diet, the skin lesions abated.