Hyper pigmented skin with xanthelasma and xanthomas should lead to possibility of the diagnosis of:
The cholangiocyte is a target of an immune-mediated inflammatory response, as is characteristic of primary biliary cirrhosis Primary biliary cirrhosis Primary biliary cirrhosis is occurs predominantly in women. Patients may present with jaundice, pruritus and fatigue is common. The skin is often hyperpigmented and detection of xanthelasma or xanthomata related to hypercholesterolemia is highly suggestive of the diagnosis. Serologic testing (antimitochondrial antibodies) is generally sufficient to establish a diagnosis Ref:Sleisenger and Fordtran's,E-9,P-328
Primary biliary cirrhosis
Primary sclerosing cholangiti
Amyloidosis
Tuberculosis