Intense pulsed light and chemical peels improved pigmentation in 2 patients who developed laser-induced chrysiasis decades after receiving gold salt therapy for rheumatoid arthritis.
The first patient, aged 60 years, had received intramuscular gold salts from 1989 to 1994 and had no prior evidence of chrysiasis. She developed persistent grayish-blue pigmentation following 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser photorejuvenation. The second patient, aged 70 years, had received gold salts 36 years earlier and developed diffuse facial grayish-blue pigmentation within 24 hours following treatment with 1064- and 532-nm picosecond lasers.
Both patients subsequently received 4 sessions of 695-nm intense pulsed light (IPL) combined with a 25% trichloroacetic acid (TCA) peel. The first patient underwent treatment every 2 weeks, with the peel applied only to pigmented areas, and had an approximately 90% reduction in pigmentation after the fourth session. The second patient had moderate improvement after 4 sessions but elected to discontinue treatment.
Additional testing in the second patient supported an association between short-pulse laser exposure and the pigmentation. Test sites treated with 1064- and 532-nm picosecond lasers developed similar dark pigmentation, whereas a site treated with a 1064-nm long-pulse laser did not. Histopathologic findings in both patients were consistent, showing dermal metallic deposits; in the first patient, deposits stained positively with Grocott methenamine silver but negatively for hemosiderin and melanin.
Chrysiasis is a rare manifestation of persistent gold deposition characterized by blue-gray pigmentation, typically in photoexposed skin. Laser-induced chrysiasis is rarer still, with fewer than 10 cases reported in the literature, according to the researchers. Its mechanism remains incompletely understood, although they proposed that laser energy may fragment dermal gold particles through photoacoustic or photomechanical effects, altering light scattering and accentuating the Tyndall effect. Oxidation and redistribution of gold particles may also contribute.
The report was limited by its 2-patient case design, which precludes conclusions about the broader efficacy or safety of IPL combined with TCA peeling. Treatment response also differed between the patients, with approximately 90% pigmentation reduction in 1 and only moderate improvement in the other. The rarity of the condition limits the available evidence.
The cases suggest that a history of chrysotherapy may remain clinically relevant decades after treatment and should be considered before short- or ultrashort-pulse laser procedures. IPL combined with chemical peeling may offer a treatment option when laser-induced chrysiasis occurs, although evidence is limited to case reports. “A history of gold salt use must always be obtained before short- or ultra-short-pulsed laser treatments,” wrote lead author Rosemarie Mazzuco, of Éclat Dermatologie by Rosemarie Mazzuco in Balneário Camboriú, Brazil, and colleagues.
The authors reported no funding or conflicts of interest.
Source: Journal of Cosmetic Dermatology