What are the differential diagnoses for eruptive xanthomas, and how would you manage this patient?
A moderately obese, 29-year-old man presented with a three week history of an increasing number of red papules with a slightly yellow hue on his trunk and limbs. The papules were a little itchy intermittently. At presentation, the patient had hundreds of the papules on his trunk and proximal limbs (Figure 1). There were no other relevant skin findings, lipaemia retinalis or hepatosplenomegaly.
The patient was well with no prior history of significant illness. He was not taking any medication, but 18 months ago he had stopped taking atorvastatin (Lipitor) for hypercholesterolaemia and hypertriglyceridaemia (at this stage, his peak total cholesterol and triglyceride levels had been 8.5 and 5.4 mmol/L, respectively). He reported that he was a smoker and drank three to four serves of alcohol a week. No one in his family had a skin problem. His mother and father had hypercholesterolaemia, and his father also had hypertriglyceridaemia; however, there was no family history of early heart disease, diabetes or thyroid problems.