Chrysiasis revisited: a clinical and pathological study

Area of Science:

• Dermatology
• Rheumatology
• Toxicology

Background:

• Chrysiasis is a permanent skin pigmentation caused by parenteral gold salt administration.
• It is a known side effect in patients treated with gold salts for conditions like rheumatoid arthritis.
• Understanding its development and clinical presentation is crucial for patient management.

Purpose of the Study:

• To investigate the clinical features and dose-dependency of chrysiasis in Caucasian patients with rheumatoid arthritis.
• To correlate the degree of pigmentation with gold deposition in the skin.
• To highlight the importance of accurate diagnosis and potential preventive measures.

Main Methods:

• A study was conducted on 40 Caucasian patients with rheumatoid arthritis treated with intramuscular sodium aurothiomalate.
• Clinical observation of skin pigmentation, particularly in light-exposed areas.
• Assessment of gold content and deposition in dermal layers.

Main Results:

• Chrysiasis was observed in 31 out of 40 patients (77.5%).
• Visible pigmentation appeared above a threshold of 20 mg/kg gold content.
• Pigmentation severity correlated with cumulative gold dose and was characterized by a progressive mauve to blue/slate-grey discoloration, initially periorbital and extending to the face, neck, and upper limbs.
• Focal aggregates of particulate gold were found in the dermis, correlating with pigmentation intensity.

Conclusions:

• Chrysiasis is a common, dose-dependent side effect of parenteral gold therapy in rheumatoid arthritis patients.
• Early identification is essential to prevent misdiagnosis and ensure appropriate patient care.
• Reducing sun exposure may be a helpful preventive strategy, though chrysiasis is difficult to prevent entirely.