Yellow Papules on a Middle-aged Woman

REPORT OF A CASE  A 54-year-old woman with a two-year history of hypertriglyceridemia was seen in the dermatology clinic of the New Jersey Medical School, Newark, with a pruritic rash of five to six weeks' duration. The patient first noticed the eruption on her right knee after receiving penicillin prophylaxis for dental surgery and was treated with antihistamines by her physician for an "allergic reaction." The eruption slowly spread to involve the elbows, trunk, and distal extremities. Pruritus increased in severity and was most marked along the lateral aspects of the breasts. She had no history of any skin eruptions.The patient's medical history was remarkable for rheumatic fever and hypertriglyceridemia of unknown cause. She had no history of pancreatitis, diabetes mellitus, or liver disease, and there was no family history of hyperlipidemia.Physical examination revealed a mildly obese woman with a generalized eruption of small yellow papules surrounded by