A 21-year-old woman with a history of poorly controlled diabetes mellitus presented with a 5-week history of an itchy rash. She reported a recent hospitalization for pancreatitis and a family history of paternal hypertriglyceridemia. Examination revealed numerous pink-to-yellow dome–shaped papules on her back, buttocks, bilateral legs, and arms, accentuated on extensor surfaces (Figures 1 and 2). Although eruptive xanthomas were favored clinically, the differential diagnosis also included multicentric reticulohistiocytosis, disseminated granuloma annulare, and sarcoidosis. Histopathology confirmed extracellular lipid along with intradermal foamy histiocytes (Supplemental Figures 1 and 2, available online at http://www.mayoclinicproceedings.org). Laboratory findings revealed a triglyceride level of 3130 mg/dL (to convert to mmol/L, multiply by 0.0259). On the basis of clinical, histopathological, and laboratory findings, the patient was diagnosed with eruptive xanthomas.Figure 2Clinical image of multiple yellowish papules on the forearm.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Hypertriglyceridemia can be inherited through lipoprotein lipase deficiency or familial hypolipoproteinemia or because of secondary causes such as diabetes mellitus, obesity, alcohol, or estrogen supplementation.1Yuan G. Al-Shali K.Z. Hegele R.A. Hypertriglyceridemia: its etiology, effects and treatment.CMAJ. 2007; 176: 1113-1120Crossref PubMed Scopus (389) Google Scholar Cutaneous xanthomas result when lipids deposit in the dermis within macrophages, known as foam cells, and in the extracellular matrix. They can be divided into eruptive, tuberous, tendon, verruciform, and planar xanthomas. Eruptive xanthomas are associated with elevated serum chylomicron levels and thus hypertriglyceridemia, often exceeding 3000 mg/dL.2Durrington P. Dyslipidaemia.Lancet. 2003; 362: 717-731Abstract Full Text Full Text PDF PubMed Scopus (317) Google Scholar The accumulation of lipid presents as pruritic yellow papules, most commonly on the buttocks and extensor surfaces of extremities. Diagnosis can be confirmed by histopathology with a histiocytic perivascular infiltrate, extracellular lipid, and lipidized macrophages.3Merola J.F. Mengden S.J. Soldano A. Rosenman K. Eruptive xanthomas.Dermatol Online J. 2008; 14: 10Crossref PubMed Google Scholar Failure to diagnose and treat hyperlipidemia leads to an increased risk of atherosclerosis, cardiovascular disease, and pancreatitis.4Sarwar N. Danesh J. Eiriksdottir G. et al.Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies.Circulation. 2007; 115: 450-458Crossref PubMed Scopus (1079) Google Scholar,5Roga G. Jithendriya M. Eruptive xanthoma: warning sign of systemic disease.Cleve Clin J Med. 2016; 83: 715-716Crossref PubMed Scopus (6) Google Scholar Along with lifestyle modification, treatment of hypertriglyceridemia with fibrates or niacin results in regression of xanthomas while aiming to prevent systemic complications.5Roga G. Jithendriya M. Eruptive xanthoma: warning sign of systemic disease.Cleve Clin J Med. 2016; 83: 715-716Crossref PubMed Scopus (6) Google Scholar A 21-year-old woman with a history of poorly controlled diabetes mellitus presented with a 5-week history of an itchy rash. She reported a recent hospitalization for pancreatitis and a family history of paternal hypertriglyceridemia. Examination revealed numerous pink-to-yellow dome–shaped papules on her back, buttocks, bilateral legs, and arms, accentuated on extensor surfaces (Figures 1 and 2). Although eruptive xanthomas were favored clinically, the differential diagnosis also included multicentric reticulohistiocytosis, disseminated granuloma annulare, and sarcoidosis. Histopathology confirmed extracellular lipid along with intradermal foamy histiocytes (Supplemental Figures 1 and 2, available online at http://www.mayoclinicproceedings.org). Laboratory findings revealed a triglyceride level of 3130 mg/dL (to convert to mmol/L, multiply by 0.0259). On the basis of clinical, histopathological, and laboratory findings, the patient was diagnosed with eruptive xanthomas. Hypertriglyceridemia can be inherited through lipoprotein lipase deficiency or familial hypolipoproteinemia or because of secondary causes such as diabetes mellitus, obesity, alcohol, or estrogen supplementation.1Yuan G. Al-Shali K.Z. Hegele R.A. Hypertriglyceridemia: its etiology, effects and treatment.CMAJ. 2007; 176: 1113-1120Crossref PubMed Scopus (389) Google Scholar Cutaneous xanthomas result when lipids deposit in the dermis within macrophages, known as foam cells, and in the extracellular matrix. They can be divided into eruptive, tuberous, tendon, verruciform, and planar xanthomas. Eruptive xanthomas are associated with elevated serum chylomicron levels and thus hypertriglyceridemia, often exceeding 3000 mg/dL.2Durrington P. Dyslipidaemia.Lancet. 2003; 362: 717-731Abstract Full Text Full Text PDF PubMed Scopus (317) Google Scholar The accumulation of lipid presents as pruritic yellow papules, most commonly on the buttocks and extensor surfaces of extremities. Diagnosis can be confirmed by histopathology with a histiocytic perivascular infiltrate, extracellular lipid, and lipidized macrophages.3Merola J.F. Mengden S.J. Soldano A. Rosenman K. Eruptive xanthomas.Dermatol Online J. 2008; 14: 10Crossref PubMed Google Scholar Failure to diagnose and treat hyperlipidemia leads to an increased risk of atherosclerosis, cardiovascular disease, and pancreatitis.4Sarwar N. Danesh J. Eiriksdottir G. et al.Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies.Circulation. 2007; 115: 450-458Crossref PubMed Scopus (1079) Google Scholar,5Roga G. Jithendriya M. Eruptive xanthoma: warning sign of systemic disease.Cleve Clin J Med. 2016; 83: 715-716Crossref PubMed Scopus (6) Google Scholar Along with lifestyle modification, treatment of hypertriglyceridemia with fibrates or niacin results in regression of xanthomas while aiming to prevent systemic complications.5Roga G. Jithendriya M. Eruptive xanthoma: warning sign of systemic disease.Cleve Clin J Med. 2016; 83: 715-716Crossref PubMed Scopus (6) Google Scholar We thank Cacey Peters, MD, from Department of Dermatology, the University of Tennessee Health Science Center, for providing the supplemental images. Supplemental Online MaterialSupplemental Figure 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)