A 26 year-old woman with familial hypercholesterolaemia Type II A (a high LDL-cholesterol, a low HDL-cholesterol and a normal triglyceride level) presented with multiple subcutaneous xanthomas of all digits of both hands (Fig 1A). The masses were localised around the interphalangeal joints, were relatively small in size and were not causing any functional problems. However, the patient requested excision for cosmetic reasons. Pre-operative investigations confirmed the diagnosis. Debulking of the periarticular subcutaneous masses of the middle finger was done under a digital block. Histopathology confirmed lipid-laden macrophage proliferation consistent with xanthomas. No early recurrence was noted and the patient was pleased with the cosmetic result. Six months later, the ring finger proximal interphalangeal joint masses were debulked (Fig 1B). Further surgery on the remaining digits is planned as an out-patient.In the hand, patients with hypercholesterolaemia may present with carpal tunnel syndrome (xanthomas acting as space occupying lesions within the carpal tunnel) and trigger fingers (because of flexor tendon xathomas) and scattered dorsal subcutaneous masses (Yensel and Karalezli, 2006). The presence of periarticular subcutaneous masses of the digits in our patient is very unusual and we could not find any similar case in the literature. Furthermore, we examined several members of the same family with various manifestations of Type IIA hypercholesterolaemia and none had similar hand involvement. The hands in our patient also exhibited multiple xanthelasma-like skin lesions, similar to those seen on the eyelids in this condition. These could have been excised but it was felt that the resulting scars would have been more disfiguring than the lesions.Reference Yensel U, Karalezli N (2006). Carpal tunnel syndrome and flexion contracture of the digits in a child with familial hypercholestrolaemia. Journal of Hand Surgery, 31B: 154-155.