Question

A middle aged female patient was referred to her primary physician for a lipid evaluation by her dermatologist after she developed a papular rash over her trunk and arms. The rash consisted of multiple, red, raised lesions with yellow centers. She has no previous history of such a rash and no family history of lipid disorders or CHD. She is on a standard estrogen replacement therapy as she is postmenopausal, otherwise she is healthy. Lab work for her lipid evaluation is as follows:

Serum was noted as grossly lipemic

Triglycerides	6,200 mg/dL
Total Cholesterol	458 mg/dL
Fasting Glucose	160 mg/dL
Liver Function Tests and Electrolytes	Normal

Questions:

1. What is the rash? What is the cause of her rash?

2. Is her oral estrogen contributing to her condition?

3. Is her glucose level contributing to her condition?

4. What treatment(s) are warranted, and what is her most *acute* risk?

Answer 1

Ans : 1) Rash : An area of small red spots that appear on your skin when you are ill or have a reaction to something.

Cause of her Rash : This might be due to infections, heat allergies or some medications as she is going through estrogen replacement therapy.

Ans : 2) This is not sure that oral estrogen can cause rashes because allergic contact dermatitis from estrogen is extremely rare , but local side effects from Estradiol systems must be kept in mind and correctly diagnosed.

Ans : 3) As her glucose level is high (160mg/dl) and people with diabetes, especially highly diabetic patients need to check for skin problems like rashes or bumps. So, her glucose level must be contributing in her rashes.

Ans : 4) Treatment usually is not required, but some cases might benefit from a topical steroid medicine.

​​​​​Example : Hydrocortisone.

Acute Risks could be cellulitus, but management of an acute episode depends on it's surity.