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December 2005

Multiple Firm, Painless Erythematous Papules With a Yellowish Hue—Diagnosis

Arch Dermatol. 2005;141(12):1595-1600. doi:10.1001/archderm.141.12.1595-h

The punch biopsy specimen demonstrated a dermal infiltrate of foamy cells (lipid-filled macrophages) in small foci surrounded by lymphocytes, histiocytes, and neutrophils. On admission, the patient was treated with insulin and simvastatin for his hyperglycemia and hyperlipidemia. Subsequent laboratory workup (8 days after admission) after overnight fasting revealed an atherogenic lipoprotein profile (low levels of high-density lipoprotein cholesterol, relatively higher levels of low-density lipoprotein (LDL) cholesterol, low levels of apolipoprotein A-I, and high levels of apolipoprotein B); an abnormal electrophoretic lipid pattern (a low high-density lipoprotein cholesterol fraction and an elevated very-LDL [VLDL] cholesterol fraction [no intermediate-density lipoprotein cholesterol fraction could be detected]); hyperchylomicronemia; and a significantly elevated lipoprotein(a) level. Laboratory tests at that time revealed the following values: cholesterol, 525 mg/dL (13.60 mmol/L); triglycerides, 1230 mg/dL (13.90 mmol/L); and glucose, 126 to 220 mg/dL (7.0-12.2 mmol/L) (RRs as listed previously). During 2 months of follow-up, the patient’s skin lesions decreased in size and number, and no new lesions developed.