Ronald F . Fletcher and Josephine Gloster

Since the original description (1) in 1850 of "vitiligoidea" in association with chronic jaundice and diabetes, it has become apparent that lipid containing fibrous masses, now called xanthomata, may appear in the skin and occasionally other tissues in many disorders of lipid metabolism (2). The commonest form, xanthoma of the eyelids (xanthelasma), and some of the rarer disseminated types may occur in patients with normal serum lipids (2, 3). However, the larger xanthomata (tuberous on pressure areas such as elbows, knees, and buttocks, and tendinous in the tendons) are almost always associated with an increase in the patient's total serum lipids. Xanthomata from different sites are similar histologically (2). There is much fibrous and connective tissue with conglomerations of sudanophilic material mostly in foam cells; giant cells may be present. In older lesions nests of cholesterol crystals may be seen. Xanthomata may wax and wane with rise and fall in the serum lipids (4), and it has long been supposed that the lipids in the lesions may be derived from the serum (5). Credence would be given to this hypothesis if the lipids in the xanthomata were the same as in the serum lipids, but published data are sparse and were mostly accumulated before satisfactory methods of separating small amounts of the lipid classes and fatty acids became available. Because of the continuing interest in the interrelationships of tissue and serum lipids, we thought the problem worth reexamining.