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3 types of reaction to gold merit discussion. First, there is the effect known as black dermographism, in which stroking with certain metals immediately produces well-defined black lines on the skin. Some gold alloys are amongst such metals. The evidence indicates that the effect is the result of impregnation of the skin with black metallic particles generated by mechanical abrasion of the metal by contaminants of the skin. There is no positive and unequivocal evidence of the ability of metals to mark uncontaminated skin so rapidly that it is possible to write upon it. Secondly there are the 2 related phenomena of the wear of gold jewelry, and the susceptibility to certain individuals to blackening of the skin where it is in contact with such jewelry. The occurrence of smudge, as it is often called, is not very common, but is brought to the attention of most jewelers from time to time. In extreme cases it may make it embarrassing for the person concerned to wear metallic jewelry. It would appear as if gold smudge also results mainly from mechanical abrasion of jewelry, though this may be aided and/or supplemented in some instances by corrosion of gold or gold alloy induced by certain components of the sweat. Finally, there is the question of true allergic responses to contact of the skin with gold and its alloys. Judging from the very few cases which have been recorded, such responses are extremely rare. Some recent observations on the reactions of metallic gold with amino acids and of reaction to contact of the skin with gold on the part of rheumatoid arthritis patients undergoing gold therapy, are, however, relevant in this connection.

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