Cohen Philip R, Ross E Victor
Department of Dermatology, University of California San Diego, San Diego, California.
Division of Dermatology, Scripps Clinic, San Diego, California.
J Clin Aesthet Dermatol. 2015 Sep;8(9):48-53.
Chyriasis is an uncommon side effect that occurs in patients who are receiving prolonged treatment with either intravenous or intramuscular gold as a distinctive blue-gray pigmentation of light-exposed skin. Laser-induced chrysiasis is a rarely described phenomenon in individuals who have received systemic gold and are subsequently treated with a Q-switched laser.
To describe the characteristics of patients with laser-induced chrysiasis.
The authors describe a 60-year-old woman who developed chrysiasis at Q-switched alexandrite laser treatment sites. They also reviewed the medical literature using PubMed, searching the terms chrysiasis, gold, and laser-induced. Patient reports and previous reviews of these subjects were critically assessed and the salient features are presented.
Including the authors' patient, laser-induced chrysiasis has been described in five Caucasian arthritis patients (4 women and 1 man); most of the patients had received more than 8g of systemic gold therapy during a period of 3 to 13 years. Gold therapy was still occurring or had been discontinued as long as 26 years prior to laser treatment. All of the patients immediately developed blue macules at the Q-switched laser treatment site. Resolution of the dyschromia occurred in a 70-year-old woman after two treatment sessions with a long-pulsed ruby laser and the authors' patient after a sequential series of laser sessions using a long-pulsed alexandrite laser, followed by a nonablative fractional laser and an ablative carbon dioxide laser.
Laser-induced chrysiasis has been observed following treatment with Q-switched lasers in patients who are receiving or have previously been treated with systemic gold. It can occur decades after treatment with gold has been discontinued. Therefore, inquiry regarding a prior history of treatment with gold-particularly in older patients with arthritis-should be considered prior to treatment with a Q-switched laser. Also, treatment with a long-pulsed laser should be entertained in patients with either idiopathic or laser-induced chrysiasis. (JClinAesthetDermatol. 2015;8(9):48-53.) Chrysiasis is a distinctive blue-gray pigmentation of light exposed skin occurring in individuals who are receiving parenteral gold therapy.1 The 755nm Q-switched alexandrite laser is effective for the treatment of facial lentigines since the melanin granules absorb a high proportion of the laser energy and other chromophores offer little competitive absorption.2 The authors describe a woman who developed chrysiasis at Q-switched alexandrite laser treatment sites and whose dyschromia was successfully treated with a sequential series of laser sessions using a long-pulsed alexandrite laser, followed by a nonablative fractional laser and an ablative carbon dioxide laser.
色素沉着是一种不常见的副作用，发生于接受静脉或肌肉注射金盐长期治疗的患者，表现为暴露部位皮肤出现独特的蓝灰色色素沉着。激光诱导的色素沉着是一种在接受全身金盐治疗后又接受调Q激光治疗的个体中很少被描述的现象。
描述激光诱导色素沉着患者的特征。
作者描述了一名60岁女性，在调Q紫翠宝石激光治疗部位出现色素沉着。他们还使用PubMed检索医学文献，搜索词为色素沉着、金盐和激光诱导。对这些主题的患者报告和既往综述进行了严格评估，并呈现了显著特征。
包括作者的患者在内，已有5例白种人关节炎患者（4名女性和1名男性）被描述为激光诱导色素沉着；大多数患者在3至13年期间接受了超过8g的全身金盐治疗。金盐治疗在激光治疗前仍在进行或已停止长达26年。所有患者在调Q激光治疗部位立即出现蓝色斑疹。一名70岁女性在接受两次长脉冲红宝石激光治疗后色素沉着消退，作者的患者在依次接受一系列长脉冲紫翠宝石激光治疗，随后是非剥脱性分次激光和剥脱性二氧化碳激光治疗后色素沉着消退。
在接受或既往接受全身金盐治疗的患者中，调Q激光治疗后观察到激光诱导色素沉着。它可能在停止金盐治疗数十年后发生。因此，在调Q激光治疗前，应考虑询问患者既往金盐治疗史，尤其是老年关节炎患者。此外，对于特发性或激光诱导色素沉着的患者，应考虑使用长脉冲激光治疗。（《临床美容皮肤科杂志》。2015年；8（9）：48 - 53。）色素沉着是接受胃肠外金盐治疗的个体中暴露部位皮肤出现的独特蓝灰色色素沉着。1 755nm调Q紫翠宝石激光对治疗面部雀斑有效，因为黑色素颗粒吸收大部分激光能量，而其他发色团几乎没有竞争性吸收。2 作者描述了一名女性，在调Q紫翠宝石激光治疗部位出现色素沉着，其色素沉着通过依次接受一系列长脉冲紫翠宝石激光治疗，随后是非剥脱性分次激光和剥脱性二氧化碳激光治疗而成功治愈。
