Hypersensitivity to gold in gold sodium thiomalate-induced dermatosis

Abstract

Gold compounds are widely used in the treatment of rheumatoid arthritis. Mucocutaneous side-effects leading to the discontinuation of medication are common with these drugs. We investigated whether allergic mechanisms are involved in dermatosis induced by gold sodium thiomalate (GSTM). Thirteen gold dermatosis patients, 15 arthritis patients without any side-effects from GSTM and 11 healthy controls participated in the study. Venous blood lymphocytes from these subjects were cultured with GSTM and gold sodium thiosulphate (GSTS) in the lymphocyte proliferation test (LPT). In some cases, interferon-gamma-producing cells were enumerated in vitro (T-cell ELISpot). The subjects were also patch-tested with GSTM and GSTS. The LPT to either GSTM, GSTS or both was positive in 12 of 13 patients with gold dermatosis. In the arthritis patient group without side-effects from gold, the LPT gave two false-positive results and in the healthy control group the LPT was falsely positive with one subject. T-cell ELISpot was positive in four of six gold dermatosis patients and negative in the arthritis and healthy control groups. Only one patient who also developed contact dermatitis from gold jewellery was positive to gold in the patch test. These results indicate that gold dermatosis is mediated, at least in part, by allergic mechanisms and that the LPT is of value in the diagnosis of gold dermatosis.

Chrysotherapy: a synoptic review

“…A roughly 90-fold range of values between rash-affected areas in different patients indicated that the absolute concentrations of gold were not directly related to rash initiation and that the mechanisms precipitating the development of skin rashes were probably not strictly dose dependent [3]. Based on studies with RA patents without side effects from gold sodium thiomalate, gold dermatosis patients, and healthy controls, authors concluded that gold dermatosis was mediated, in part, by allergic mechanisms; the lymphocyte proliferation test was recommended in the diagnosis of gold dermatosis [55].…”

“…Adverse side effects included skin rashes; protein in the urine; inflammation of the mouth; reduction in the number of circulating leukocytes; decreased number of blood platelets; aplastic anemia due to organ damage; lung abnormalities; adverse immune reactions, such as stomatitis, eosinophilia, lymphadenopathy, hypergamma globulinemia; severe hypotension, angina, myocardial infarction, nephrotoxicity and nephrotic syndrome; hepatitis; colitis; and chrysiasis (pigmentation) of the cornea, lens, and skin [3,8,14,44,50,52,53,57]. The most common side effect of chrysotherapy was skin toxicity, accounting for up to 60 % of all adverse reactions, especially lichenoid eruptions and non-specific dermatitis [3,47,54,55]. When chrysotherapy was discontinued, it was usually due to adverse mucocutaneous side effects during the first 2 years, and inefficacy after 4 years [56].…”

Clinical implications of in vitro drug-induced interferon gamma release from peripheral blood lymphocytes in cutaneous adverse drug reactions

“…[6][7][8] Drug-specific T cells may orchestrate the inflammatory skin reaction through release and induction of different cytokines. 5 Accordingly, T-cellemediated sensitization to drugs may be assessed in vitro by assays based on cytokine release from peripheral blood lymphocytes, such as macrophage migration inhibitory factor, 9,10 interferon gamma, [11][12][13][14][15][16][17][18][19][20][21] interleukin (IL)-5, 22,23 or other cytokines.…”

Gold und seine anorganischen Verbindungen [MAK Value Documentation in German language, 2006]

“…Bei zwei von 15 Rheuma-Patienten ohne Hautsymptomatik und bei einer von elf gesunden Kontrollpersonen lieferte der LTT ein falschpositives Ergebnis. Im Epikutantest reagierte nur einer von 13 Patienten mit Hautsymptomatik und keiner aus den beiden anderen Gruppen positiv auf 0,5%iges Natriumdithiosulfatoaurat(I) in Vaseline (Räsänen et al 1999). Ein LTT mit Tetrachlorogold(III)säure (in einem Konzentrationsbereich zwischen 1 und 30 mg/ml) war bei 13 von 17 Patienten positiv, die eine Golddermatitis infolge der Rheumabehandlung entwickelt hatten.…”