Eruptive Xanthomas: A Dermatologic Clue to the Diagnosis of an Underlying Metabolic Disorder

A 32-year-old man presented to the dermatology department with generalized asymptomatic yellowish papules on an erythematous base, arms, thighs, and buttocks. These lesions had appeared in the previous month (Figure 1). Dermoscopy revealed a homogeneous yellow color, corresponding to dermal xanthomatous deposits, with interconnected fine and dotted vessels (Figure 2). The laboratory findings showed extremely high levels of triglycerides (4.842 mg/dL; normal <150), as well as increased total cholesterol (576 mg/dL; normal <200), fasting blood glucose (294 mg/dL), and glycated hemoglobin 12.3% (normal range 4% to 6%). A skin biopsy demonstrated foamy cells, with extracellular lipid between collagen bundles in the dermis (Figure 3).