DÄ internationalArchive13/2018Skin Changes Revealing a Disorder of Lipid Metabolism

Clinical Snapshot

Skin Changes Revealing a Disorder of Lipid Metabolism

Dtsch Arztebl Int 2018; 115: 231. DOI: 10.3238/arztebl.2018.0231

Weins, A B; Biedermann, T; Brockow, K

LNSLNS
Disseminated, generalized, orange-yellow, flat, hard papules (detail), partly in mulberry-like clusters, affecting limbs and body
Disseminated, generalized, orange-yellow, flat, hard papules (detail), partly in mulberry-like clusters, affecting limbs and body
Figure
Disseminated, generalized, orange-yellow, flat, hard papules (detail), partly in mulberry-like clusters, affecting limbs and body

A 30-year-old man complained of a progressively severe, itchy rash of several weeks‘ duration. He reported suffering from polydipsia and hyperhidrosis but felt otherwise well. Examination of the skin revealed generalized orange-yellow, flat, hard papules, partly in mulberry-like clusters, most prominently affecting the extensor surfaces of the limbs and gluteal region. His past medical history and drug history were unremarkable except for obesity. Laboratory tests revealed hypertriglyceridemia (6470 mg/dL [70–200]), hypercholesterolemia (748 mg/dL [140–240]), and hyperglycemia (glucose 404 mg/dL [70–110], HbA1c 11.2% [<5.7]), without any evidence of an occult adrenal tumor. The diagnosis of eruptive xanthomas was histopathologically confirmed. The patient was treated for newly diagnosed diabetes mellitus and mixed hyperlipoproteinemia, and the rash regressed within weeks. Eruptive xanthomata are associated with dyslipidemia and can therefore be a marker of a metabolic disorder. By recognizing their typical appearance, a physician may be able to diagnose a previously occult underlying disease whose prompt treatment can prevent both short-term complications, such as pancreatitis, and long-term ones, such as coronary heart disease.

Dr. med. Andreas Benedikt Weins, Prof. Dr. med. Tilo Biedermann, Prof. Dr. med. Knut Brockow, Klinikum rechts der Isar,
Technische Universität München, Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, andreas.weins@mri.tum.de

Conflict of interest statement
The authors declare that no conflict of interest exists.

Cite this as:
Weins AB, Biedermann T, Brockow K: Skin changes revealing a disorder of lipid metabolism. Dtsch Arztebl Int 2018;
115:231. DOI: 10.3238/arztebl.2018.0231

Translated from the original German by Ethan Taub, M.D.

Disseminated, generalized, orange-yellow, flat, hard papules (detail), partly in mulberry-like clusters, affecting limbs and body
Disseminated, generalized, orange-yellow, flat, hard papules (detail), partly in mulberry-like clusters, affecting limbs and body
Figure
Disseminated, generalized, orange-yellow, flat, hard papules (detail), partly in mulberry-like clusters, affecting limbs and body