What are the other Names for this Condition? (Also known as/Synonyms)

• Chrysoderma

What is Chrysiasis? (Definition/Background Information)

• Chrysiasis is the bluish-grey discoloration of skin on sun-exposed areas, typically caused by gold therapy, which is administered for rheumatoid arthritis (RA)
• This dermatological condition is rare and is associated with long-term treatment using gold salts. However, the skin discoloration is persistent and usually permanent
• The main complication of Chrysiasis includes cosmetic issue causing emotional stress, due to the irreversible nature of the skin condition
• Generally, individuals with Chrysiasis may have received intramuscular gold-based injections for a long period of time (usually many years). These gold injections not only affect the skin, but other parts of the body too, such as the kidney or liver, due to gold toxicity
• Currently, there is no treatment available for Chrysiasis. In some cases, laser therapy has brought about limited success. Following onset of Chrysiasis, the stoppage or discontinuation of gold therapy will not cure or reverse the condition

Who gets Chrysiasis? (Age and Sex Distribution)

• Chrysiasis is an infrequent dermatological side effect that occurs in individuals who have been treated with gold-based medications for rheumatoid arthritis
• There is no specific preference for any gender (both males and females are affected)
• All racial and ethnic groups are affected and no predilection is observed

What are the Risk Factors for Chrysiasis? (Predisposing Factors)

• Individuals with rheumatoid arthritis who receive long-term intramuscular injections containing gold, as part of therapy, are at risk for Chrysiasis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chrysiasis? (Etiology)

Chrysiasis is caused by the administration of gold-based therapy as part of treatment for rheumatoid arthritis, which usually takes place for many years.

• Gold is generally administered (in oral tablet form or as injections) to reduce joint inflammation and pain caused by RA
• This condition occurs when the gold particles cause an immune reaction in the skin

When gold is injected to the muscles, it can also travel to different parts of the body causing toxicity, since gold is a foreign body.

What are the Signs and Symptoms of Chrysiasis?

The skin pigmentation may change following exposure to gold-based medications; sometimes, the change is immediate, while in other cases, the skin can change in color many years after the therapy is stopped.

The signs and symptoms associated with Chrysiasis include:

• The presence of blue-grey to purple-grey skin, mostly on the sun-exposed areas of the body
• The common areas affected include the chest, back, arms, neck, face, and the feet
• The eyes (sclera or white of the eye) may also be affected, in which case the condition is known as ocular Chrysiasis
• Signs and symptoms of underlying rheumatoid arthritis

There may be underlying gold toxicity signs and symptoms (due to gold therapy), which can include:

• Inflammation of skin, or dermatitis
• Damage to the kidneys, or nephritis
• Damage to the platelet function causing thrombocytopenia purpura
• Inflammation of blood vessels, known as vasculitis

How is Chrysiasis Diagnosed?

The diagnosis of the Chrysiasis may involve:

• A complete physical examination and an assessment of the individual’s medical history including history and treatment of rheumatoid arthritis with gold
• Computed tomography (CT) and magnetic resonance imaging (MRI) scan
• Tissue biopsy of the affected skin: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: The biopsy of skin can reveal presence of gold particle using technique such as mass spectroscopy.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chrysiasis?

The complications associated with Chrysiasis can include:

• The presence of discolored and permanent skin patches on the face and neck can cause cosmetic issues and disfigurement in the affected individuals
• This can lead to severe emotional and mental stress
• Severe gold toxicity may result in many vital organs being affected

How is Chrysiasis Treated?

There is no cure for Chrysiasis and there are not many treatment options available.

• Some individuals have tried to use laser therapy on skin with limited results
• Alternative therapy for rheumatoid arthritis should be considered

How can Chrysiasis be Prevented?

• Currently, there are no specific methods or guidelines to prevent Chrysiasis
• Avoid skin exposure to sunlight and artificial ultraviolet light (such as through tanning)
• The gold-based therapy injections that caused the condition may be discontinued or alternative medications used. However, Chrysiasis is an irreversible condition

What is the Prognosis of Chrysiasis? (Outcomes/Resolutions)

• Chrysiasis is a permanent side effect of gold therapy on skin, which is used for treating rheumatoid arthritis
• Discontinuing the therapy responsible for the side effect will generally not reverse the condition and Chrysiasis can be present for a lifetime

Additional and Relevant Useful Information for Chrysiasis:

• In 50% of the individuals, the injections (given as part of therapy for various arthritic forms) may not be an effective treatment tool
• Because of the heavy side effects and newer, advanced treatments for arthritis, gold therapy is on the decline; hence, gold toxicity is less frequently seen nowadays