CHRYSIASIS REVISITED - A CLINICAL AND PATHOLOGICAL-STUDY

Chrysiasis is a distinctive and permanent pigmentation of light-expose d skin resulting from the administration of parenteral gold salts. We report a study of 40 Caucasian patients with rheumatoid arthritis, tre ated with intramuscular sodium aurothiomalate, of whom 31 had chrysias is. Visible changes develop above a threshold, equivalent to 20 mg/kg gold content, and their severity depends upon cumulative dose. Focal a ggregates of particulate gold are deposited in the reticular and papil lary dermis in amounts that correlate with the degree of pigmentation. Characteristically, initially the periorbital region is affected by a mauve discoloration, which intensifies and deepens into a blue/slate- grey colour, while extending to involve the face, neck and upper limbs . Although chrysiasis develops insidiously and patients may be unaware of the changes, positive identification is important in order to avoi d misdiagnosis and medical mismanagement, and afford appropriate reass urance. Prevention is difficult, but measures to reduce sunlight expos ure may be helpful.