Chrysiasis is a rare dermatological condition characterized by a distinctive discoloration of the skin. This unusual pigmentation arises from the deposition of gold particles within the body’s tissues. The condition is an uncommon side effect of historical medical treatments.
What is Chrysiasis?
Chrysiasis presents as a bluish-gray to purple-brown staining of the skin. The discoloration is most noticeable in areas frequently exposed to sunlight, such as the face, neck, and hands. The white part of the eye, known as the sclera, can also show this pigmentation.
This unique skin color results from gold salts accumulating in the deeper layers of the skin. The gold particles deposit in the dermis, often appearing as black or dark brown granules. The presence of these gold deposits in the upper dermis contributes to the bluish hue seen on the skin.
The Gold Standard of the Past
Chrysiasis historically developed as a consequence of “chrysotherapy,” or gold therapy, a medical practice that involved administering gold compounds to treat certain diseases. This treatment was widely used for conditions like rheumatoid arthritis, psoriatic arthritis, lupus, and Sjogren’s disease. Gold compounds were employed due to their anti-inflammatory properties.
Gold salts reduced inflammation in the joint lining and helped prevent joint and cartilage destruction in rheumatoid arthritis patients, though their precise mechanism was not fully understood. Prolonged administration led to the accumulation of gold particles in various tissues, including the skin. The risk of developing chrysiasis increased with the total cumulative dose of gold received. This practice has largely been replaced by safer and more effective alternatives like methotrexate, making chrysiasis a rare condition today.
Recognizing the Signs
Recognizing chrysiasis primarily involves observing the characteristic skin discoloration and obtaining a detailed patient history regarding past gold therapy. The pigmentation often begins as a mauve discoloration around the eyes, gradually deepening into a blue or slate-gray color and spreading to other sun-exposed areas. While the skin discoloration is the most prominent sign, systemic symptoms are not typically associated with chrysiasis itself, although gold toxicity could affect other organs like the liver and kidneys.
Confirmation of chrysiasis often involves a skin biopsy. Under light microscopy, aggregates of gold are visible in the reticular and papillary dermis, often concentrated around blood vessels. Advanced diagnostic tools can enhance the visibility of gold particles and confirm the presence of gold elements within the tissue. Differentiating chrysiasis from other conditions causing similar skin discoloration, such as argyria (silver deposition) or minocycline-induced hyperpigmentation, is important for accurate diagnosis.
Living with Chrysiasis
The skin discoloration associated with chrysiasis is permanent and does not reverse even after discontinuing gold therapy. Once established, there is no specific active medical treatment to reverse the color. The condition is benign and primarily a cosmetic concern, though it can cause emotional distress for affected individuals.
While chrysiasis itself does not usually pose ongoing health problems, sun protection is important as exposure to sunlight can make the pigmentation more pronounced. Individuals with a history of gold salt therapy should also be cautious with laser treatments, as localized chrysiasis has been reported to develop at laser treatment sites.