A Laser-Induced Chrysiasis Treated With Pulsed Intense Light and Chemical Peels

BACKGROUNDGold salts (chrysotherapy) were widely used for the treatment of moderate to severe rheumatoid arthritis during the 1990s. Following administration, gold particles may deposit permanently in multiple tissues, including the skin. Exposure to ultraviolet radiation can induce a characteristic blue-gray pigmentation known as chrysiasis. More recently, short- and ultra-short-pulse lasers have also been implicated in triggering chrysiasis, although the underlying mechanism remains poorly understood.

OBJECTIVETo describe two cases of laser-induced chrysiasis occurring decades after chrysotherapy and to propose a simple treatment approach using intense pulsed light (IPL) and chemical peels.

METHODSTwo patients with a remote history of gold salt therapy for rheumatoid arthritis, discontinued more than 30 years earlier, developed facial blue-gray pigmentation following laser procedures. Clinical findings, treatment strategy, and outcomes were evaluated.

RESULTSBoth patients presented with laser-induced chrysiasis affecting sun-exposed facial areas. Treatment combining IPL sessions and chemical peels resulted in rapid and significant improvement in pigmentation, with good cosmetic outcomes and no major adverse effects.

CONCLUSIONLaser-induced chrysiasis may occur even decades after gold salt administration. Dermatologists should routinely investigate prior chrysotherapy exposure, particularly in patients with a history of rheumatoid arthritis, before performing laser treatments. IPL combined with chemical peels may represent a safe and effective therapeutic option for managing this challenging condition.

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