generalized granuloma annulare , molluscum contagiosum , sub-epidermal calcified nodules , xanthoma disseminatum , and sarcoidosis . 2 Our patient was diagnosed with multiple molluscum contagiosum but did not respond to treatment . Moreover , there have been many cases of eruptive xanthomas misdiagnosed as molluscum contagiosum reported in the literature . 4 , 5
The management of all xanthomas involves treating the underlying hyperlipidemia , as the cutaneous lesions most often resolve once the patient ’ s lipid levels have improved . Although xanthomas are often a more cosmetic concern , it is imperative that the underlying cause be treated as there is increased morbidity and mortality associated with untreated hyperlipidemia . 1 The most common interventions to reduce lipid levels include lifestyle changes such as increased aerobic exercise , reduced smoking , and therapeutic diets along with weight management . Lipid-lowering agents are also frequently administered to help address the underlying hyperlipidemia , with differing agents used to treat different lipid abnormalities . Statins are often immediately initiated in patients who have risk factors for atherosclerotic disease such as hyperlipidemia , although their primary mechanism is to reduce LDL-cholesterol . This is due to numerous studies showing that statins have cardio-protective effects and reduce the risk of major adverse cardiovascular events . 6-8 However , in eruptive xanthomas , where the triglyceride and chylomicrons levels are often extremely high , fibrates work more directly than statins to reduce these parameters . Thus , fibrates are often used as adjuvant therapy with statins , especially in patients with eruptive xanthomas . Other agents used include bile acid resins , niacin , omega-3 fatty acids , and PCSK9 inhibitors . The latter of these have recently been FDA approved for the treatment of dyslipidemias in patients who have been refractory to standard medical therapy . Finally , the definitive management of eruptive xanthomas involves surgical excision , especially if they are refractory to medical therapy or cause severe discomfort . Newer modalities of removal also include ablative laser therapy and cryotherapy .
References
1 . Sathiyakumar V , Jones SR , Martin SS . Xanthomas and Lipoprotein Disorders . In : Kang S , Amagai M , Bruckner AL , Enk AH , Margolis DJ , McMichael AJ , Orringer JS . eds . Fitzpatrick ' s Dermatology , 9e . Mc- Graw-Hill ;
2 . ENDOCRINE , METABOLIC , AND NUTRITIONAL DISEASES . In : Wolff K , Johnson R , Saavedra AP , Roh EK . eds . Fitzpatrick ' s Color Atlas and Synopsis of Clinical Dermatology , 8e . McGraw-Hill
3 . Bolognia JL , Braverman IM . Skin Manifestations of Internal Disease . In : Jameson J , Fauci AS , Kasper DL , Hauser SL , Longo DL , Loscalzo J . eds . Harrison ' s Principles of Internal Medicine , 20e . McGraw-Hill ;
4 . Sorrell J , Salvaggio H , Garg A , Guo L , Duck SC , Paller AS . Eruptive xanthomas masquerading as molluscum contagiosum . Pediatrics . 2014 Jul ; 134 ( 1 ): e257-60
5 . Digby M , Belli R , McGraw T , Lee A . Eruptive xanthomas as a cutaneous manifestation of hypertriglyceridemia : a case report . J Clin Aesthet Dermatol . 2011 Jan ; 4 ( 1 ): 44-6 .
6 . Davignon J . The cardioprotective effects of statins . Curr Atheroscler Rep . 2004 Jan ; 6 ( 1 ): 27-35 .
7 . Byrne P , Cullinan J , Smith A , Smith SM . Statins for the primary prevention of cardiovascular disease : an overview of systematic reviews . BMJ Open . 2019 ; 9 ( 4 ): e023085 .
8 . Taylor F , Huffman MD , Macedo AF , et al . Statins for the primary prevention of cardiovascular disease . Cochrane Database Syst Rev . 2013 ; 201
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