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Case Reports
. 2025 Feb 1;17(2):e78329.
doi: 10.7759/cureus.78329. eCollection 2025 Feb.

Cutaneous Manifestation of Eruptive Xanthoma as a Consequence of Severe Hypertriglyceridemia: A Case Report Highlighting Diagnostic and Therapeutic Challenges

Jeremi Morka  1 , Aleksandra Morajko  1 , Sylwia Otulak  1 , Karolina Zarańska  2   3 , Grażyna Wąsik  2   3
Affiliations
Case Reports

Cutaneous Manifestation of Eruptive Xanthoma as a Consequence of Severe Hypertriglyceridemia: A Case Report Highlighting Diagnostic and Therapeutic Challenges

Jeremi Morka et al. Cureus. .

Abstract

Eruptive xanthomas are clinical manifestations of lipid-laden foam cells in the dermis. The morphological subtype and anatomical location of xanthomas can provide insight into the underlying lipid disorder. Hyperlipidemia, a common condition in the general population, is categorized as primary or secondary depending on disruptions in endogenous or exogenous lipoprotein pathways. We describe the case of a 29-year-old female with severe obesity who presented with numerous yellow papules on the trunk, buttocks, and extensor surfaces of the lower limbs, persisting for three months without subjective symptoms. Examination revealed inflammatory halos around some of the lesions. Dermoscopy showed irregularly shaped, light-yellow areas on a dense, yellowish background. Laboratory investigations revealed extreme hypertriglyceridemia (>4000 mg/dL), elevated total cholesterol (>1000 mg/dL), reduced high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels and undetectable aminotransferase levels. The patient met the criteria for metabolic syndrome and was newly diagnosed with diabetes mellitus. A diagnosis of eruptive xanthomas was made, linked to impaired triglyceride clearance and hepatic overproduction of triglyceride-rich lipoproteins secondary to diabetes, obesity, excessive caloric intake, and oral contraceptive use. The Fredrickson classification system identified hypertriglyceridemia as part of types I, IV, and V hyperlipoproteinemia. This case highlights the significance of a comprehensive diagnostic approach in patients with xanthomas, taking into account associated risk factors, family history, and lipoprotein abnormalities for early detection. Prompt treatment can lead to the complete resolution of eruptive xanthomas and prevent fatal complications such as acute pancreatitis.

Keywords: eruptive xanthomas; hypertriglyceridemia; lipid disorders; lipid-laden foam cells; metabolic syndrome; obesity.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Diffused eruption of papules: lesions on patient's back (A), right forearm (B), tights (C), buttocks (D)
Figure 2
Figure 2. Papules on the skin presented as isolated lesions (A) or in clusters (B)
Figure 3
Figure 3. Dermoscopy image of the papules under polarized light
See this image and copyright information in PMC

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