High-dose oestrogen contraceptives can cause severe hypertriglyceridaemia in patients with type III hyperlipoproteinaemia, which can be managed with lower oestrogen doses, clofibrate, and dietary restriction.
Hypothesis-generating that lower-oestrogen contraceptives plus clofibrate and diet may resolve xanthomata in type III; single case leaves generalizability open.
We report a woman who had a moderate elevation of serum triglycerides with a type III pattern of hyperlipoproteinaemia when taking a normal diet. She developed eruptive xanthomata with a grossly raised serum triglyceride concentration and chylomicronaemia when pregnant and also when taking a combined oral contraceptive pill containing 50 microgram of oestrogen. The xanthomata cleared and the triglyceride level fell when the combined oral contraceptive pill was changed to one with a lower oestrogen content, clofibrate was prescribed and the diet was restricted in carbohydrate and fat. Persistent chylomicronaemia is a serious complication of pregnancy because of the risk of pancreatitis and the potential risk of fetal malnutrition. Treatment with diet and clofibrate is indicated. High oestrogen-containing contraceptive pills appear to be contraindicated in patients with type III or other hypertriglyceridaemic states.
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Muller et al. (1978) studied this question.
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