Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2023;13(1):e2023025 1

Eruptive Xanthoma as a Sign of Underlaying  
Severe Metabolic Disorder

Jordana Rigolon de Lara1, Gabriela Momente Miquelin2, 
Jan Lapins4, Elizabeth Leocadia Fernades3

1 University of Mogi das Cruzes (UMC), Brazil

2 University of Mogi das Cruzes (UMC); Brazilian Society of Dermatology, Brazil

3 Dermatoscopy and Melanoma clinic at UNITAU; Brazilian Society of Dermatology; International Dermoscopy Society, Brazil

4 Departament of Dermatology, Karolinska University Hospital and Karolinska Institutet, Sweden

Keywords: eruptive xanthoma, hypertriglyceridemia, dermoscopy, xanthomatosis

Citation: Rigolon de Lara J, Momente Miquelin G, Lapins J, Leocadia Fernades E. Eruptive Xanthoma as a Sign of Underlaying Severe 
Metabolic Disorder. Dermatol Pract Concept. 2023;13(1):e2023025. DOI: https://doi.org/10.5826/dpc.1301a25

Accepted: May 1, 2022; Published: January 2023

Copyright: ©2023 Rigolon de Lara et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Jordana Rigolon de Lara, Av. Prefeito Carlos Ferreira Lopes, 635, Apto 172, ZIP code: 08773-490,  
Mogi das Cruzes - SP, Brazil. E-mail: jordanarigolon@gmail.com

Case Presentation

A 40-year-old woman presented with a 2 year history of 

multiple asymptomatic yellow-erythematous papules and 

plaques on the upper limbs, extending to the trunk and 

lower limbs. Dermatoscopy showed aggregates of white to 

yellow clods on a structureless pink background. History of 

type 2 diabetes mellitus. Laboratory abnormalities occurred: 

triglycerides 6137 mg/dl (0-149 mg/dl), glucose 317 mg/dl 

(65-99 mg/dl). Histopathological examination revealed xan-

thomatous cells with immunohistochemistry: CD68+ in nu-

merous histiocytes, compatible with eruptive xanthoma.

Teaching Point

Eruptive xanthomas develop in cases of pronounced and 

abrupt onset hypertriglyceridemia and are characterized by 

small, yellow, cutaneous papules, 1-4 mm in diameter, with 

an erythematous halo around the base. They appear sud-

denly in crops over pressure points and extensor surfaces 

of the arms, legs, and buttocks. These forms of xanthomas 

develop exclusively in the presence of lactescent plasma and 

severe hypertriglyceridemia [1].

Hypertriglyceridemia causes morbidity and mortality by 

significantly increasing the risk of atherosclerosis, cardiovas-

cular disease and stroke. In addition, there is an increased 

risk of acute pancreatitis [2].

It is therefore very important to recognize the clinical and 

dermatoscopic features of the cutaneous presentation of this 

severe metabolic disease and request adequate laboratory 

workup and initiate appropriate treatment.



2 Image Letter | Dermatol Pract Concept. 2023;13(1):e2023025

References

1. Parker F. Xanthomas and hyperlipidemias.  J Am Acad Derma-

tol. 1985;13(1):1-30. DOI:10.1016/s0190-9622(85)70139-9. 

PMID: 4031142.

Figure 1. (A, B) Multiple yellow-erythematous papules and plaques. (C) Dermatoscopy showed aggregates of white to yellow clods on a 

structureless pink background.

2. Nessel TA, Kerndt CC, Bills JA, Sikorski L. Eruptive 

 xanthomas: a warning sign of future hyperlipidemia compli-

cations. Int J Res Dermatol. 2020;6:579-583. DOI:10.18203/

issn.2455-4529.