Avoid gold. . . I'm wondering if it is what has lead to this lichen planus sore
area on my gum which I've had for over two years now. I used some colloidal
gold about 6 months before I got the sores. I also started wearing mineral
makeup. (Lichen planus is most common in middle age people.) Non-steroidal
anti-inflammatories and blood pressure drugs have also been blamed in some
articles. I just found these articles.
Pat
Nowadays gold is still highly sought for its many uses, including in jewelry,
dental prostheses, photography, and electronic circuits. However, its
attractive, shiny color and its strong association with luxury and beauty ate
being used in misleading ways by some companies that are now adding it to skin
care products.
Historical Use for Medicinal Purposes
The Chinese were the first to prepare and use red colloidal gold as an
alchemical drug for longevity (Int. J. Neurosci. 2002;112:31-53). Red colloidal
gold is still used in India and prescribed by Ayurvedic physicians under the
name of swarna bhasma (red gold).
In the 16th century, Paracelsus recommended gold preparations for the treatment
of epilepsy, and by the 19th century, gold was used to treat many conditions,
including epilepsy, depression, migraine, amenorrhea, impotence, and
alcoholism. As 20th century medicine developed, gold disappeared from the
pharmacopoeias, except as a treatment for rheumatoid arthritis (RA).
The original rationale behind the use of gold for rheumatoid arthritis was its
effectiveness as an antibiotic for tuberculosis (as described by German
physician Robert Koch around 1890), based on the widely held assumption that
rheumatoid arthritis was caused by mycobacteria. In the 1930s the French doctor
Jacques Forestier developed the use of gold drugs for the treatment of
rheumatoid arthritis, giving birth to modern "chrysotherapy" or "aurotherapy,"
defined as the application of gold compounds to medicine (J. Lab. Clin. Med.
1935;20:827-40; Chem. Rev. 1999;99:2589-600).
Gold drugs have been used since then to treat this and other autoimmune
diseases, but the treatment can cause severe side effects, which have notably
diminished the use of gold-containing drugs in recent years.
Mechanism of Action
The mechanism of action by which gold drugs affect RA is still a matter of
debate. Recent studies suggest that gold plays an important role in the
initiation of the immune reaction, namely the uptake and presentation of
foreign antigens (Z. Rheumatol. 2001;60:167-73). Moreover, gold has been shown
to suppress NF-kappaB--binding activity as well as the activation of
I-kappaB-kinase, resulting in reduced production of proinflammatory cytokines
such as tumor necrosis factor-[alpha], interleukin-1, and interleukin-6 (J.
Immunol. 2000;164:5981-9; Ann. Rheum. Dis. 1994;53:315-22).
Despite a well-documented anti-inflammatory effect, no scientific studies have
demonstrated that gold "firms and revitalizes the skin," "reduces wrinkles," or
gives the skin % plumped golden glow," as many skin-care manufacturers claim.
After a meticulous literature search, only a handful of papers written in the
mid- 1960s that explored the reactions of intramuscular gold with collagen were
found. In 1964, Adam et al. showed for the first time the binding of gold to
collagen in rat tail tendon in vivo using electron microscopy. The authors
concluded that intramuscular administration of gold sodium thiosulfate results
in an increased number of collagen cross-linkages, leading to greater
structural stability of the collagen in tendons (Experientia 1964;20:203-4).
A few years later, in 1968, Adam et al. expanded their study and reported on
changes in the collagen of rat skin under the influence of this metal. Their
results showed that the treatment of rats with intramuscular gold thiosulfate
does increase the structural stability of skin collagen by introducing
additional cross-links. The stabilization was manifested as an increase in
insoluble collagen content, decreased solubility under denaturing conditions,
and greater resistance to protease attack (Eur. J. Biochem. 1968;3:411-4).
Intermolecular cross-links between collagen molecules have been shown to be
essential in providing collagen matrices with stability and tensile strength,
as well as in making them more resistant to enzymatic degradation (J. Invest.
Dermatol. 1991;97:938-41).
However, cross-linkage of collagen with other compounds also occurs normally
with chronological aging (Ann. Rheum. Dis. 1965;24:378-81) and some authors,
such as Yamauchi et al., have proposed that the progressive formation of stable
collagen networks by the continuous increase in stable cross-link content may
serve to slow collagen turnover (Biochem. Biophys. Res. Commun. 1988;
152:898-903).
No studies were found on the effects of topical gold on collagen in the skin of
animals or humans, or any other study exploring the effects of topical gold on
skin. This evidence points to a lack of serious scientific research behind the
addition of gold to skin care products that promise to provide an antiaging
effect.
Adverse Effects
Toxic reactions occur in approximately 32% of patients receiving intramuscular
gold sodium thiomalate (Myochrysine) for rheumatoid arthritis ("Arthritis and
Allied Conditions" [Philadelphia: Lea and Febiger, 1972, pp. 455-82]). Skin
reactions account for 60% of these side effects (Ann. Rheum. Dis.
1960;19:95-119).
There is a broad spectrum of cutaneous side effects following gold therapy. In
most cases a nonspecific dermatitis can be observed, mainly on the chest, arms,
and legs. The skin lesions may also mimic lichen planus, pityriasis rosea, or
various forms of eczema, obscuring early diagnosis (Z. Rheumatol.
1986;45:100-6).
Histologically, Hofmann et al. described four types of reactions caused by
gold: a dermatitis type, a vasculitis type, a lichenoid type, and an urticarial
type (Z. Rheumatol. 1986;45:100-6).
Lichen Planus
Lichen planus is an inflammatory mucocutaneous condition with characteristic
violaceous polygonal flat-topped papules and plaques that are intensely
pruritic.
Involvement of the oral mucosa is common, and this condition can be
debilitating in severe cases. Oral lichen planus classically presents on the
buccal mucosa as a white, lacy, reticular pattern, but erosive lesions can also
occur. Erosive lesions in particular may be exquisitely painful and can lead to
secondary infections; and the pain can lead to poor nutrition and dehydration.
Moreover, patients with long-term oral mucosal lesions have an increased risk
of developing squamous cell carcinoma in the lesions (Oral Surg. Oral Med. Oral
Pathol. 1985;60:30-4).
While most cases of lichen planus are idiopathic, some are caused by the
ingestion of certain medications, notably gold. Furthermore, the association
between oral lichen planus and the use of gold in dental restorations has been
well established for many years (Am. J. Contact Dermatitis 2001;12:146-50).
Interestingly, dermatitis from jewelry is not always seen in patients with oral
mucosal reactions attributed to gold (Contact Dermatitis 1995;33:323-8).
In addition to many case reports of oral lichen planus secondary to
gold-containing dental restorative materials, there have been cases of linear
lichen planus on the lower extremities and nail lichen planus secondary to
gold-containing dental fillers, all of which improved with the removal of the
gold dental restoration (Br. J. Dermatol. 2005;152:1087-9;J. Dermatol.
1996;23:890-2). There have even been cases of cutaneous lichen planus after the
consumption of Goldschlager, a gold-containing cinnamon liquor (N. Engl. J.
Med. 1996;334:603).
Gold Allergy
Prior to the 1980s, allergies to gold were thought to be rare, with only a few
cases reported. Because it was thought to be immunologically inert, gold was
rarely tested for among dermatologists and allergists. This situation allowed
gold allergy to go undetected, and gold was considered an insignificant
allergen ("Fisher's Contact Dermatitis, 5th ed." [Philadelphia: Williams &
Wilkins; 2001]). Gold was added to the North American Contact Dermatitis Group
(NACDG) standard screening panel in the 1996-1998 series, and quickly became
the sixth most common allergen (J. Am. Acad. Dermatol. 1998;38:911-8).
The recognition of gold as a significant sensitizer and as the second most
common metal allergen (only after nickel) led to the designation of gold as
Allergen of the Year in 2001 by the American Contact Dermatitis Society (Adv.
Dermatol. 2004;20:237-55).
An interesting feature of gold allergy is the propensity for facial and eyelid
dermatitis to occur. In fact, gold was the most frequently encountered allergen
associated with eyelid dermatitis in the most recent NACDG data (2003-2004)
(Dermatitis 2007;18:78-81).
It is important to note that gold does not often cause a reaction under
jewelry. Rather, reactions are seen in areas where gold comes in contact with
eye makeup, foundation, and sunscreens, which are items that might contain
metal compounds such as titanium dioxide and zinc oxide. These harder metals
abrade the gold, leading to the release of sensitizing gold particles. Mineral
makeup is thought to be a frequent culprit.
Notably, both the dermatitis and the positive patch test reactions caused by
gold may persist for months after exposure; in one case, the reaction was
reported to last for 18 months ("Fisher's Contact Dermatitis, 5th ed.,"
[Philadelphia: Lippincott Williams & Wilkins, 2001]; Dermatologica
1971;142:209-18).
Conclusions
Despite the evidence demonstrating gold's anti-inflammatory efficacy with oral
or intramuscular use, no studies looking at its efficacy and safety in the skin
have been published. The effects of topical gold on the skin are unknown, but
its potential and serious side effects are, including contact dermatitis and
lichen planus, as well as its exorbitant cost: a 1.7-ounce bottle of Orlane
Creme Royale, which contains 24-karat liquid gold, costs $650. Gold leaf
facials ate the current trend in many beauty magazines and are found at
high-end spas for $500 and up.
Companies that incorporate gold into their products should be encouraged to
perform a well-designed trial to look at the efficacy, and very importantly,
the safety of topical gold before consumers feel the impact, not only on their
pocketbooks but also on their skin health.
DR. BAUMANN is director of cosmetic dermatology at the University of Miami. To
respond to this column, or to suggest topics for future columns, write to Dr.
Baumann at our editorial offices via e-mail at [email protected].
DR. MARIA PAZ CASTANEDO-TARDAN, a dermatology fellow at the University of
Miami, also contributed to this month's column.
__________________________________________________________________________________________________________
After the Gold Rash.By: Berger, Joanne M.
Publication: Family Practice News
Date:Sunday, April 15 2001
You are viewing page 1
Here's a nugget at wisdom: Drinking gold may be hazardous to your skin. At a
dermatology meeting, a Kentucky physician described an 18-year-old patient with
a 3-week history of brownish-red scaly papules on his trunk and extremities.
The man did not respond to a mild topical corticosteroid and an
antihistamine (for suspected pityriasis rosea) or to doxycycline (for suspected
pityriasis lichenoides). Then the patient revealed that he'd been drinking
large amounts of Goldschlager, a cinnamon schnapps that contains gold flakes,
on a nightly basis. After he was advised to stop, his condition cleared in a
few days. An earlier case study (N. Engl. J. Med. 334[9]:603, 1996) described a
24-year-old man who developed lichen planus after drinking Gold-schlager for 1
year; his symptoms also cleared when he stopped. With Gold-schlager priced at
about $25 a bottle, don't expect to see a, um, rash of such cases.
_______________________________________________________________________________________________________
But what they fail to address is that while gold was once injected as a
medication for certain inflammatory diseases like arthritis, the treatment has
been largely discontinued due to the manifold side effects.
In a nutshell, there's no evidence that gold is good for the skin - and plenty
of evidence that it can be bad. This skin care trend worries me for two
reasons:
* 1) Allergies: Gold allergies are on the rise - at an alarming rate.
Remember, while we all associate gold with luxury, it's still a metal, and you
can develop an allergy to it. Perhaps you're thinking, "well, I'm safe - no
$600 face creams here!" But in an interesting development, some of my
colleagues in the dermatological community believe that the rise of mineral
makeup is contributing to this rise in gold allergies. The theory is that those
minerals, like bismuth and mica, scratch off small particles of gold from
jewelry, eventually introducing that gold to the skin and causing the body to
mount an allergic reaction. Gold allergy isn't an all or nothing thing - you
can develop it slowly over time.
* 2) Lichen Planus: A skin disease that causes purple papules, lichen
planus is known to be caused by gold. For example, in 1996, when Goldschlager -
a liquor that includes gold particles - was popular, there was an outbreak of
lichen planus associated with the trend.
--
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