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Curious Cutanieous Eruptive Xanthoma

Ariel Benjamin Vazquez

A 46 year old male presented to urgent care clinic because of recent onset of a rash on his arms and elbows. Patient stated he had been lowering some trees in some unspecified time in the future before presentation and several other 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 point with dermatitis and prescribed steroid cream. After seven days the patient followed up with a medical aid 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 point. Patient was diagnosed with an eruptive cutaneous xanthoma and began on a fibrate together 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 in step with cutaneous xanthoma. After increased compliance with medications and tight glucose control the patient’s lesions regressed and resolved.