Curious Cutanieous Eruptive Xanthoma

Curious Cutanieous Eruptive Xanthoma

A 46 year old male presented to urgent care clinic due to recent onset of a rash on his arms and elbows. Patient stated he had been cutting down some trees one day prior to presentation and several leaves had fallen on his arms where the rash was present. The patient described the rash as reddish yellow pustules, reported they were itchy. The patient was diagnosed at that time with contact dermatitis and prescribed steroid cream. After seven days the patient followed up with a primary care physician and was complaining of continued lesions on his arms bilaterally with no improvement since using the steroid cream. The patient stated he attempted to expulse material from several of the lesions and was unsuccessful. The lesions looked increasingly yellowish at that time. Patient was diagnosed with an eruptive cutaneous xanthoma and started on a fibrate along with medication compliance education for his diabetes medications and statin.  A hemoglobin A1C was tested at the patient’s visit and resulted elevated at greater than 14. Punch biopsy was obtained and lipid panel was ordered. Fasting lipid panel resulted in triglycerides of 1901, punch biopsy showed foam cells consistent with cutaneous xanthoma. After increased compliance with medications and tight blood glucose control thepatient’s lesions regressed and resolved.