Article Type
Changed
Tue, 09/12/2017 - 10:54
Display Headline
Eruptive xanthoma

To the Editor: The article “Eruptive xanthoma” by Drs. Mahmoud Abdelghany and Samuel Massoud1 described the management of a patient with severe hypertriglyceridemia associated with skin lesions. The authors noted that both metformin and statin doses were increased upon diagnosis. In addition, insulin was initiated.

The Endocrine Society guidelines note that statins have a modest triglyceride-lowering effect, typically about 10% to 15%, and may be useful to modify cardiovascular risk in patients with moderately elevated triglyceride levels.2 In addition, they recommend fibrates as the first-line therapy for these patients, with the addition of fish oil, statins, or niacin as needed.

During the management of acute hypertriglyceridemia, the enzyme lipoprotein lipase needs to be activated to aid in the breakdown of triglycerides. This can be accomplished with therapies such as insulin,3 fibrates, and even heparin.4 In addition, medium-chain triglycerides (such as coconut or palm kernel) are cleared by the portal circulation, so they can be used for cooking in patients predisposed to severe hypertriglyceridemia.

References
  1. Abdelghany M, Massoud S. Eruptive xanthoma. Cleve Clin J Med 2015; 82:209–210.
  2. Berglund L, Brunzell JD, Goldberg AC, et al; Endocrine Society. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:2969–2989.
  3. Thuzar M, Shenoy VV, Malabu UH, Schrale R, Sangla KS. Extreme hypertriglyceridemia managed with insulin. J Clin Lipidol 2014; 8:630–634.
  4. Garg A, Simha V. Update on dyslipidemia. J Clin Endocrinol Metab 2007; 92:1581–1589.
  5. Shah AS, Wilson DP. Primary hypertriglyceridemia in children and adolescents. J Clin Lipidol 2015 (In press).
Article PDF
Author and Disclosure Information

Alyson Myers, MD
North Shore Hospital, Manhasset, NY

Issue
Cleveland Clinic Journal of Medicine - 82(8)
Publications
Topics
Page Number
473
Legacy Keywords
eruptive zanthoma, triglycerides, hypertriglyceridemia, Mahmoud Abdelghany, Samuel Massoud, Alyson Myers
Sections
Author and Disclosure Information

Alyson Myers, MD
North Shore Hospital, Manhasset, NY

Author and Disclosure Information

Alyson Myers, MD
North Shore Hospital, Manhasset, NY

Article PDF
Article PDF
Related Articles

To the Editor: The article “Eruptive xanthoma” by Drs. Mahmoud Abdelghany and Samuel Massoud1 described the management of a patient with severe hypertriglyceridemia associated with skin lesions. The authors noted that both metformin and statin doses were increased upon diagnosis. In addition, insulin was initiated.

The Endocrine Society guidelines note that statins have a modest triglyceride-lowering effect, typically about 10% to 15%, and may be useful to modify cardiovascular risk in patients with moderately elevated triglyceride levels.2 In addition, they recommend fibrates as the first-line therapy for these patients, with the addition of fish oil, statins, or niacin as needed.

During the management of acute hypertriglyceridemia, the enzyme lipoprotein lipase needs to be activated to aid in the breakdown of triglycerides. This can be accomplished with therapies such as insulin,3 fibrates, and even heparin.4 In addition, medium-chain triglycerides (such as coconut or palm kernel) are cleared by the portal circulation, so they can be used for cooking in patients predisposed to severe hypertriglyceridemia.

To the Editor: The article “Eruptive xanthoma” by Drs. Mahmoud Abdelghany and Samuel Massoud1 described the management of a patient with severe hypertriglyceridemia associated with skin lesions. The authors noted that both metformin and statin doses were increased upon diagnosis. In addition, insulin was initiated.

The Endocrine Society guidelines note that statins have a modest triglyceride-lowering effect, typically about 10% to 15%, and may be useful to modify cardiovascular risk in patients with moderately elevated triglyceride levels.2 In addition, they recommend fibrates as the first-line therapy for these patients, with the addition of fish oil, statins, or niacin as needed.

During the management of acute hypertriglyceridemia, the enzyme lipoprotein lipase needs to be activated to aid in the breakdown of triglycerides. This can be accomplished with therapies such as insulin,3 fibrates, and even heparin.4 In addition, medium-chain triglycerides (such as coconut or palm kernel) are cleared by the portal circulation, so they can be used for cooking in patients predisposed to severe hypertriglyceridemia.

References
  1. Abdelghany M, Massoud S. Eruptive xanthoma. Cleve Clin J Med 2015; 82:209–210.
  2. Berglund L, Brunzell JD, Goldberg AC, et al; Endocrine Society. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:2969–2989.
  3. Thuzar M, Shenoy VV, Malabu UH, Schrale R, Sangla KS. Extreme hypertriglyceridemia managed with insulin. J Clin Lipidol 2014; 8:630–634.
  4. Garg A, Simha V. Update on dyslipidemia. J Clin Endocrinol Metab 2007; 92:1581–1589.
  5. Shah AS, Wilson DP. Primary hypertriglyceridemia in children and adolescents. J Clin Lipidol 2015 (In press).
References
  1. Abdelghany M, Massoud S. Eruptive xanthoma. Cleve Clin J Med 2015; 82:209–210.
  2. Berglund L, Brunzell JD, Goldberg AC, et al; Endocrine Society. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:2969–2989.
  3. Thuzar M, Shenoy VV, Malabu UH, Schrale R, Sangla KS. Extreme hypertriglyceridemia managed with insulin. J Clin Lipidol 2014; 8:630–634.
  4. Garg A, Simha V. Update on dyslipidemia. J Clin Endocrinol Metab 2007; 92:1581–1589.
  5. Shah AS, Wilson DP. Primary hypertriglyceridemia in children and adolescents. J Clin Lipidol 2015 (In press).
Issue
Cleveland Clinic Journal of Medicine - 82(8)
Issue
Cleveland Clinic Journal of Medicine - 82(8)
Page Number
473
Page Number
473
Publications
Publications
Topics
Article Type
Display Headline
Eruptive xanthoma
Display Headline
Eruptive xanthoma
Legacy Keywords
eruptive zanthoma, triglycerides, hypertriglyceridemia, Mahmoud Abdelghany, Samuel Massoud, Alyson Myers
Legacy Keywords
eruptive zanthoma, triglycerides, hypertriglyceridemia, Mahmoud Abdelghany, Samuel Massoud, Alyson Myers
Sections
Disallow All Ads
Alternative CME
Article PDF Media