Localized chrysiasis induced by laser therapy.
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.


METHODS
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 Q-switched 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 physiochemical modification in gold deposits induced by UV light may explain the localization of chrysiasis to sun-exposed skin in affected patients.
D015535:Arthritis, Psoriatic / Q000188:drug therapy; D001706:Biopsy; D003461:Crystallography; D004577:Electron Probe Microanalysis; D005148:Facial Dermatoses / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006052:Gold Sodium Thiomalate / Q000009:adverse effects / Q000378:metabolism / Q000528:radiation effects / Q000627:therapeutic use; D006099:Granuloma / Q000628:therapy; D006801:Humans; D017495:Hyperpigmentation / Q000628:therapy; D007834:Lasers / Q000009:adverse effects*; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D010789:Phototherapy / Q000009:adverse effects*; D010859:Pigmentation Disorders / Q000209:etiology* / Q000473:pathology; D012867:Skin / Q000648:ultrastructure
D006052:Gold Sodium Thiomalate