Eruptive xanthomas are a consequence of severe chylomicronemia and hypertriglyceridemia. They are accumulations of lipid-laden macrophages that present abruptly as pruritic, small, yellow-to-orange papules most commonly scattered over the buttocks and extensor surfaces of extremities. Acutely, variable amounts of pruritus or pain may be present. Hypertriglyceridemia may result from hereditary conditions such as lipoprotein lipase deficiency or familial hyperlipoproteinemia, or from secondary causes such as excessive alcohol intake, hypothyroidism, nephrotic syndrome, or diabetes mellitus. Certain medications (eg, systemic retinoids such as isotretinoin and acitretin, estrogens, protease inhibitors, cyclosporine, prednisone) are also common causes of secondary hypertriglyceridemia. Triglyceride levels in patients with eruptive xanthomas often exceed 3000-4000 mg/dl. Triglyceridemia in the range of 1500 mg/dL or greater can also lead to pancreatitis.
The skin lesions usually resolve within 6 months with appropriate treatment.
Eruptive xanthoma
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Synopsis
Codes
ICD10CM:
E78.2 – Mixed hyperlipidemia
SNOMEDCT:
238952003 – Eruptive xanthoma
E78.2 – Mixed hyperlipidemia
SNOMEDCT:
238952003 – Eruptive xanthoma
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Granuloma annulare – Skin-colored to reddish-brown papules, often forming annular plaques.
- Xanthoma disseminatum should be considered in children; presents with brown to yellow papillary rash on flexor surfaces and often on the eyelids.
- Folliculitis – Follicularly based erythematous papules and pustules.
- Pityrosporum folliculitis – Folliculocentric and often pruritic.
- Steroid acne – Predilection for chest and back, often 2-5 weeks after starting oral steroids.
- Sarcoidosis – May also affect extensor extremities but typically red-brown in color.
- Leukemia cutis – Firm, deep red-brown / plum colored.
- Langerhans cell histiocytosis – Predilection for skin folds.
- Multicentric reticulohistiocytosis – Distribution typically along acral areas (head, hands [especially periungual], and juxta-articular regions of extremities).
- Lichen amyloidosis – Often with rippled appearance.
- Erythema elevatum diutinum – Nodules and plaques over extensor extremities.
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:06/06/2018
Last Updated:07/01/2018
Last Updated:07/01/2018
Eruptive xanthoma