History: A 55 year-old white male with one year history of worsening rash on face, back, elbows, hips, knees, and palms was sent to dermatology for evaluation of pruritus and possible tinea versicolor. His past medical history was remarkable for primary biliary cirrhosis (PBC), and he was awaiting a liver transplant. In the meantime, he was being treated with ursodiol (Actigall) for his PBC.
Physical exam: Cachectic WM with diffuse jaundice. Peri-orbital yellow papules and plaques and facial telangiectasias (fig. 1). A large V-shaped yellow plaque on his chest back and upper extremities with a distinct line of demarcation (fig. 2). Red-yellow papules and nodules on bilateral elbows and knees (fig. 3). A well-demarcated yellow plaque on his right hip and yellow discoloration of his palmar surfaces were also noted.
Total Cholesterol 678, HDL 14, LDL 607, Triglycerides 190.
Alkaline phosphatase 721, Bilirubin 6.7, AST 89, ALT 36
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