EpistemisEruptive xanthomas
Specialty: Skin.
Why it occurs
- Severe primary hypertriglyceridemia (familial chylomicronemia, lipoprotein lipase deficiency)
- Uncontrolled secondary hypertriglyceridemia due to decompensated diabetes mellitus type 1 or 2
- Acute or chronic alcohol abuse (pancreatitis due to hypertriglyceridemia and secondary dyslipidemia)
- Use of systemic retinoids (isotretinoin) or oral estrogen therapy that massively elevate triglycerides
- Nephrotic syndrome with severe alteration of lipoprotein metabolism.
Initial workup
Complete fasting lipid profile (total cholesterol, triglycerides, HDL, LDL, VLDL), fasting blood glucose, glycosylated hemoglobin (HbA1c), pancreatic amylase and lipase, kidney function tests (creatinine, 24-hour urine proteinuria), and liver profile.
red flags
Diffuse and intense abdominal pain radiating in a band towards the back associated with persistent nausea and vomiting (imminent signs of acute pancreatitis induced by hypertriglyceridemia, typically with levels greater than 1000 mg/dL), dyspnea or drowsiness.
Standard management
- Fenofibrate — drug of choice to drastically reduce circulating triglyceride levels by activating PPAR-alpha nuclear receptors; doses of 160 to 200 mg/day orally
- Rapid insulin by intravenous infusion if the patient has decompensated diabetes — favors the activation of lipoprotein lipase and acutely reduces triglycerides
- High concentration Omega-3 fatty acids — dose of 4 g daily as an adjuvant in the reduction of serum lipids
- Strict hypolipidic diet and immediate suspension of triggering factors such as alcohol.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4