Chrysiasis Y45.4

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 22.06.2022

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Synonym(s)

Chrysosis; Gold rash

Definition
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Rare dyschromia due to gold deposition in the skin.

Etiopathogenesis
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Usually after parenteral gold application. From a total amount of 150 mg/kg bw the occurrence is probable.

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Dermatology

Circumscribed scleroderma

Heterogeneous group of chronic, relapsing, sclerosing connective tissue diseases of the skin which, dependi...

Clinical features
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Slate grey, metallic shiny discolouration, especially in the area of light-exposed skin areas and sclerae.

Histology
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Fine-grained to coarse-grained deposition of gold particles on elastic fibres as well as on basal membranes (detection by darkfield technique possible). Electron microscopy: deposition of pigment granules in endothelial cells, macrophages and along elastic fibres.

Diagnosis
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Histology, dark field, atomic absorption spectrometry, neutron activation analysis.

Differential diagnosis
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Physiologic (actinic) skin pigmentation: light-emphasized as in argyrosis; the slate-gray aspect of skin discoloration is absent.

M. Addison: Generalized brown hyperpigmentation with accentuation of light-exposed areas (initially indistinguishable from normal sun tan). Furthermore, pigmentation of axillae, nipple, genital area; pigmentation of hand lines, scars, pressure points; gray-brownish mucosal pigmentation (due to increased ACTH and thus simultaneously MSH secretion), mostly porcelain-white nails (negative to surrounding brown skin), more rarely diffuse brown nail pigmentation, loss of secondary hair, tendency to hyperhidrosis.

Cyanosis: Blue-red discoloration; depending on the type of cyanosis, lips and mucous membranes are markedly cyanotic, usually a sign of heart failure.

Argyrosis: brown discoloration of the skin, light accentuated! Medication history. Clinically not easily distinguishable.

Hydrargyrosis: used to be used as a bleaching agent. The use is forbidden.

Icterus: bilirubin increase; yellowing of the sclerae; liver diseases (e.g. hepatitis, liver cirrhosis)!

Therapy
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Dose reduction, if necessary discontinuation of the therapy. As a precaution, a total amount of 150 mg/kg bw should not be exceeded. The visible pigment (subepidermal gold seam) forms under the influence of sunlight. Textile and physical/chemical sun protection (e.g. Anthelios, Eucerin Sun, see also sunscreen) are therefore an essential part of the therapy.

Successes with the pulsed dye laser (595 nm) have been reported.

Literature
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Altmeyer P et al (1975) Chrysiasis: Side effect of intramuscular gold therapy. Dermatologist 26: 330-333
Loddenkemper K et al (2002) Chrysiasis. Z Rheumatol 61: 173-174
Rütter A et al (1996) Metal dermatoses II. dermatologist 47: 400-409
Smith RW, Cawley MI (1997) Chrysiasis. Br J Rheumatol 36: 3-5
Trotter MJ et al (1995) Localized chrysiasis induced by laser therapy. Arch Dermatol 131: 1411-1414
Yun PL et al (2002) Q-switched laser-induced chrysiasis treated with long-pulsed laser. Arch Dermatol 138: 1012-1014