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.

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.