Chrysiasis

What is chrysiasis?

Chrysiasis is a condition characterised by blue-grey to greyish-purple staining of the skin caused by the deposition of gold particles in connective tissue (the deep layers of skin).

The name chrysiasis is derived from chrysos and chrysanthos, a Greek word meaning “golden flower”.

What is the cause of chrysiasis?

The source of the gold is usually from prolonged use of intravenous, intramuscular or oral gold therapy for the treatment of rheumatoid arthritis. Chrysiasis is rarely seen today as gold is rarely used for arthritis. In the early 20th century, high doses of gold were also used for the treatment of tuberculosis.

Chrysiasis may still occur in people that consume gold for some reason.

Localised blue-grey pigmentation due to chrysiasis has been rarely reported at the site of Q-Switched laser treatment in patients that had previously — even decades earlier — been treated with gold salts. 

What are the clinical features of chrysiasis? 

Chrysiasis may develop after a few months of gold treatment or after a long latent period.

• Blue-grey or purple pigmentation is usually limited to light-exposed areas of the body and to the sclera (the white part of the eye).
• Ocular chrysiasis does not affect vision.
• The nails, hair and mucous membranes such as lips are not normally affected.
• Gold deposition may also be noted in other organs such as liver and kidney, and may be asymptomatic or lead to disease.

What is the differential diagnosis of chrysiasis?

Greyish-blue pigmentation may also be due to silver deposition, argyria.

Drug-induced pigmentation due to minocycline, antimalarials and amiodarone can be a similar colour to chrysiasis.

How is chrysiasis diagnosed?

Chrysiasis is a clinical diagnosis in a patient known to have been treated with gold salts, especially if this was for a prolonged period. On skin biopsy,  light microscopy reveals aggregates of gold in the reticular and papillary dermis, in a predominantly perivascular distribution. The granules of deposited gold are generally larger and more irregular than those of sliver. 

How is chrysiasis treated?

Chrysiasis is irreversible and basically untreatable.

• Sun protection is important, as sun exposure makes the pigmentation more pronounced. 
• People who have been treated with gold salts should avoid laser treatments.
• One case of localised, laser-induced chrysiasis was reported to resolve following multiple additional laser treatments.