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Eruptive Xanthomas — SCE Dermatology MCQ

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ModerateInflammatory DermatosesEruptive XanthomasSCE Dermatology

A 35-year-old woman develops eruptive xanthomas — multiple small yellowish papules on her buttocks and extensor surfaces. Her fasting triglycerides are markedly elevated at 25 mmol/L. What is the type of xanthoma and what underlying condition should be investigated?

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Correct answer: C — Eruptive xanthoma — severe hypertriglyceridaemia (type I, IV, or V hyperlipidaemia, or secondary causes including diabetes and alcohol)

Eruptive xanthomas present as crops of small (1-4 mm) yellowish papules with erythematous halos, predominantly on buttocks, shoulders, and extensor surfaces. They are pathognomonic for severe hypertriglyceridaemia (usually >11 mmol/L). Causes include familial hypertriglyceridaemia (types I, IV, V), uncontrolled diabetes mellitus (most common secondary cause), excess alcohol, obesity, hypothyroidism, and drugs (retinoids, oestrogens, protease inhibitors). Acute pancreatitis risk from severe hypertriglyceridaemia must be managed urgently. Treatment of the underlying lipid disorder leads to resolution of the xanthomas within weeks. Tendon xanthomas indicate familial hypercholesterolaemia; xanthelasma can occur with normal or elevated lipids.

Reference: BAD 2019; NICE CG181 Lipid Modification