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December 1995

Localized Chrysiasis Induced by Laser Therapy

Author Affiliations

From the Department of Pathology (Drs Trotter and Tron and Mr Hollingdale) and the Division of Dermatology and Lions Laser Skin Centre (Dr Rivers), Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver.

Arch Dermatol. 1995;131(12):1411-1414. doi:10.1001/archderm.1995.01690240073012

Background:  Chrysiasis is a rare blue-gray skin discoloration that occurs in sun-exposed sites of some patients who receive gold salts. A unique case of localized chrysiasis developed immediately after Q-switched ruby laser (694 nm) irradiation for postinflammatory hyperpigmentation secondary to granuloma faciale in a patient who was receiving long-term gold sodium thiomalate therapy for psoriatic arthritis. Skin biopsy specimens showed striking changes in the ultrastructural characteristics of cutaneous gold deposits following laser treatment.

Observations:  A blue-gray skin discoloration developed immediately after laser exposure and persisted unchanged after 1 year. Transmission electron microscopy of skin biopsy specimens showed electron-dense gold deposits. Before laser irradiation, these deposits were 106±35 (mean±SD) nm in diameter and faceted, consistent with a crystalline structure. Posttreatment deposits were round, smaller, measured 16±4 nm, and resembled colloidal gold. Identical findings were observed in an area of sun-protected skin treated with the Qswitched ruby laser; irradiation with a pulsed dye laser at 585 nm had no effect.

Conclusions:  Localized chrysiasis was induced in a patient receiving parenteral gold therapy who underwent treatment with a Q-switched ruby laser. This form of chrysiasis resulted from a structural alteration in dermal gold deposits. A similar physicochemical modification in gold deposits induced by UV light may explain the localization of chrysiasis to sun-exposed skin in affected patients.(Arch Dermatol. 1995;131:1411-1414)

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