What are the other Names for this Condition? (Also known as/Synonyms)

• EX (Eruptive Xanthoma)

What is Eruptive Xanthoma? (Definition/Background Information)

• Eruptive Xanthoma (EX) is the formation of lesions/nodules on skin due to hypertriglyceridemia, a condition causing increased triglyceride levels in blood
• Triglycerides are certain types of fatty substances that are important for providing energy to the body. The abnormal cutaneous lesions that form on skin are called xanthomas
• Eruptive Xanthoma is generally observed in adults. The lesions are usually painless, itchy, and many in numbers. They can be present anywhere in the body; but are commonly found on the back, shoulders, and chest
• Eruptive Xanthoma develops secondary to abnormalities in fat/lipid metabolism, which develops due to an underlying genetic disorder, diabetes, or certain medications. The skin lesions are benign, but may present cosmetic issues
• In a majority of cases, treatment of the underlying disorder/diabetes through diet control, exercises, and prescription medications, is undertaken. The xanthomas may be treated through surgery or laser therapy, if required
• The prognosis for Eruptive Xanthoma is good with suitable treatment of the underlying condition causing the skin lesions. However, there is a chance of recurrence following treatment, if triglyceride levels are not maintained

Who gets Eruptive Xanthoma? (Age and Sex Distribution)

• Eruptive Xanthoma is an uncommon condition that is usually observed in adults
• Both males and females may be affected
• Individuals of all racial and ethnic background may be affected. Worldwide, no geographical localization has been reported

What are the Risk Factors for Eruptive Xanthoma? (Predisposing Factors)

Individuals with hypertriglyceridemia are at risk for developing Eruptive Xanthoma. The predisposing factors that result in elevated triglyceride levels include:

• Certain genetic disorders
• Use of certain medications
• Poorly-controlled diabetes
• Hypothyroidism
• High-fat diet and lack of physical activities/exercise
• High BMI levels: Obesity or overweight conditions
• Excess consumption of alcohol

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Eruptive Xanthoma? (Etiology)

The cause of development of Eruptive Xanthoma is due to abnormal levels of triglycerides, a type of fat in blood. It may be described as the skin manifestation of hypertriglyceridemia.

• Hypertriglyceridemia is a metabolic disorder that causes abnormal fat/lipid levels in blood, when their metabolism is affected
• Lipids in blood combine with certain proteins to form water-insoluble lipoproteins, which accumulate beneath the skin to form eruptive xanthomas
• Hypertriglyceridemia constitute the following two types:
  • Primary hypertriglyceridemia - when it occurs from a genetic disorder
  • Secondary hypertriglyceridemia - it arises secondary to an associated condition, such as diabetes mellitus, or due to certain medications, obesity, and poor diet

What are the Signs and Symptoms of Eruptive Xanthoma?

The signs and symptoms of Eruptive Xanthoma may include:

• Presence of small round to oval shaped papules that are firm to touch
• A papule is an area of abnormal skin tissue that is less than 1 centimeter around. Usually a papule has distinct borders, and it can appear in a variety of shapes
• The papules may have red-yellow-orange discoloration
• Some lesions are isolated and spaced far away from each other; while in many cases, they appear to cluster together
• The lesions are usually painless and itchy; some are tender to touch
• The papules may be seen all over the body, but they frequently involve the upper torso, buttocks, and limbs
• Lesions on the face and inside the mouth are occasionally noted

Additional signs and symptoms of the underlying/associated condition may be noted.

How is Eruptive Xanthoma Diagnosed?

A diagnosis of Eruptive Xanthoma may involve the following:

• A thorough medical history and physical examination
• Test for blood cholesterol and triglyceride levels
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: A biopsy may be performed to rule out other skin conditions with similar signs and symptoms.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Eruptive Xanthoma?

The complications of Eruptive Xanthoma may include:

• The presence of multiple lesions may result in cosmetic concerns and emotional stress
• Scratching the lesions may lead to bleeding and ulceration, which may result in secondary infections
• This may give rise to scar formation on healing
• Formation of new lesions at other body sites, or recurrence of xanthomas after treatment
• Complications that arise from the underlying genetic or metabolic disorder

How is Eruptive Xanthoma Treated?

The primary treatment of Eruptive Xanthoma involves treating the underlying metabolic disorder (hypertriglyceridemia). The treatment measures may involve:

• Undertaking treatment for the underlying condition causing Eruptive Xanthoma, which includes:
  • Appropriate diet and exercising
  • Weight control, for obese or overweight individuals; maintaining a healthy weight
  • Prescription oral or intravenously-administered medications for diabetes
  • Undergo follow-up tests and checkups to ensure that blood sugar levels are controlled
  • Avoiding or minimizing alcohol intake; quitting smoking
• Treatment of skin lesions may involve (if necessary):
  • Surgical excision and removal
  • Laser therapy
  • Use of chemical peeling agents, such as trichloroacetic acid (TCA)
  • In a majority of cases, removal of the lesions are not necessary, unless they cause worrisome signs and symptoms such as cosmetic issues

How can Eruptive Xanthoma be Prevented?

• Currently, there are no known methods available to prevent the occurrence of Eruptive Xanthoma
• However, certain steps may be taken to decrease one’s risk for the condition by controlling diabetes and keeping blood sugar at optimum levels
• Having a low-fat diet and adequate physical activities/exercises to maintain optimal weight are beneficial in keeping low triglyceride levels

Regular tests and periodic checkups to monitor the condition are recommended following treatment.

What is the Prognosis of Eruptive Xanthoma? (Outcomes/Resolutions)

• The prognosis of Eruptive Xanthoma is good with appropriate treatment of the underlying diabetes
• In many individuals, the lesions are known to spontaneously disappear with adequate management of the underlying condition causing Eruptive Xanthoma
• Chronic hypertriglyceridemia may severely affect the heart (it can result in coronary artery disease)

Additional and Relevant Useful Information for Eruptive Xanthoma:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse