Eruptive xanthomata

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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174 Eruptive xanthomata

Instruction

Examine this patient’s skin.

This uncontrolled diabetic has developed a profuse eruption; what are these lesions?

Salient features

History

• Duration and treatment of diabetes

• History of hyperlipidaemia

• Rash: duration, onset and evolution and associated symptoms such as itching.

Examination

• Multiple, itchy, red–yellow vesicles or nodules seen over extensor surfaces, i.e. buttocks, back, knees and elbows (Fig. 174.1 and see Fig. 173.1F,H).

image

Fig. 174.1 Eruptive xanthomata.

Proceed as follows:

• Tell the examiner that would like to:

• examine the fundus for lipaemia retinalis
• check the urine for sugar
• do a lipid profile (remember that eruptive xanthomata signify triglyceridaemia).

Diagnosis

This patient has eruptive xanthomata (lesion) caused by hypertriglyceridaemia (aetiology).

Advanced-level questions

In which conditions are eruptive xanthomata seen?

• Type IV hyperlipidaemia

• Familial hypertriglyceridaemia

• Lipoprotein lipase deficiency

• Apolipoprotein CII deficiency

• Type I hyperlipidaemia: chylomicronaemia

• Type V hyperlipidaemia: increased levels of triglycerides and chylomicrons.

Mention some other causes of hypertriglyceridaemia

• Primary hypertriglyceridaemia (usually >5.0 mg/l): familial hypertriglyceridaemia, familial combined hyperlipidaemia.

• Secondary hypertriglyceridaemia: diet, obesity, excess alcohol intake, diabetes mellitus, hypothyroidism, uraemia, dysproteinaemias, drugs (beta-blockers, oral contraceptives and oestrogens, retinoids).

What is the relationship between hypertriglyceridaemia and coronary artery disease?

Triglycerides are an independent risk factor for coronary artery disease irrespective of LDL cholesterol. For every increase in serum triglyceride of 890 mg/l, the risk increases by ~30% in men and ~75% in women.

What is the particular risks for patients with serum triglycerides markedly raised (>10.0 mg/l)?

They are more susceptible to acute pancreatitis and hyperchylomicronaemia.

How would you manage a patient with raised levels of serum triglycerides?

• Diet: restrict dietary fat, decrease intake of alcohol and simple sugars

• Weight loss if the patient is overweight

• Exercise

• Discontinuation of drugs, e.g. beta-blockers

• Control secondary causes

• Niacin, gemfibrozil or omega-3 fatty acids may be used to treat elevated triglycerides (>5.0 mg/l) regardless of LDL or HDL cholesterol.

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