Correspondence

Lichen Planus after Consumption of a Gold-Containing Liquor

N Engl J Med 1996; 334:603February 29, 1996

Article

To the Editor:

Idiopathic lichen planus is a pruritic papulosquamous eruption that typically occurs in middle-aged persons. The estimated prevalence of this disorder is less than 1 percent, and its cause is unclear.1 Drug-induced lichen planus has been reported after the administration of numerous medications, including gold-containing compounds.1,2 Gold-induced skin reactions may appear at any time during treatment. They generally resolve within three to four months after cessation of the drug but may persist longer.3,4

A 24-year-old man presented with a cutaneous eruption that was clinically consistent with lichen planus. He had discrete pruritic, violaceous, planar papules on the forearms, shins, and ankles, as well as fine reticulated plaques on the buccal mucosa. A skin biopsy of a lesion on the lower leg showed hyperkeratosis, focal hypergranulosis, and an inflammatory mononuclear-cell infiltrate at the dermal–epidermal junction that contained a few eosinophils. The patient had regularly consumed gold-containing cinnamon schnapps (Goldschlager; Schmid and Gassler, Lausanne, Switzerland) for approximately one year. Serum and urinary gold levels were measured by atomic absorption spectroscopy at the Mayo Clinic in Rochester, Minnesota. The initial serum gold level, measured three months after the patient had last consumed the gold-containing beverage, was 0.4 mg per liter (normal range, 0 to 0.1); the urinary gold level was 86 μg per 24-hour specimen (normal range, 0 to 1.0).

The patient was advised not to consume gold-containing liquor. The pruritic eruption gradually cleared. Three months after the first measurement, the serum gold level was less than 0.1 mg per liter, and the urinary level was less than 1.0 μg per 24-hour specimen.

Typical clinical and histologic evidence of lichen planus in such a young patient, along with the temporal course and laboratory findings, implicate the consumption of gold-containing liquor. Several brands of gold-containing cinnamon schnapps are available in the United States. Analysis of five 750-ml bottles of the Goldschlager brand showed 8 to 17 mg of gold flakes per bottle. The metallic flakes were 75 percent gold by weight, with 280 μg of gold per deciliter dissolved in the liquid portion. We estimated that the patient drank 200 to 300 ml of this beverage per week. This case suggests that gold may induce a lichenoid skin eruption when ingested in the form of gold-containing liquor, just as it does when given as a therapeutic agent. It is also possible that this eruption was related to something unique in the formulation of this brand or type of liquor.

Mark A. Russell, M.D.
Lloyd E. King, Jr., M.D., Ph.D.
Alan S. Boyd, M.D.
Vanderbilt University Medical Center, Nashville, TN 37232-5227

4 References

1. 1

   Boyd AS, Neldner KH. Lichen planus. J Am Acad Dermatol 1991;25:593-619
   CrossRef | Web of Science | Medline

2. 2

   Thompson DF, Skaehill PA. Drug-induced lichen planus. Pharmacotherapy 1994;14:561-571
   Web of Science | Medline

3. 3

   Penneys NS, Ackerman AB, Gottlieb NL. Gold dermatitis: a clinical and histopathological study. Arch Dermatol 1974;109:372-376
   CrossRef | Web of Science | Medline

4. 4

   Thomas I. Gold therapy and its indications in dermatology: a review. J Am Acad Dermatol 1987;16:845-854
   CrossRef | Web of Science | Medline

Citing Articles (5)

Citing Articles

1. 1

   A. S. Thakor, J. Jokerst, C. Zavaleta, T. F. Massoud, S. S. Gambhir. (2011) Gold Nanoparticles: A Revival in Precious Metal Administration to Patients. Nano Letters 11:10, 4029-4036
   CrossRef

2. 2

   S. M. Breathnach. 2010. Drug Reactions. , 1-177.
   CrossRef

3. 3

   S. M. Breathnach. 2010. , 1.
   CrossRef

4. 4

   Shamila S. Gunatilleke, Amy M. Barrios. (2008) Tuning the Au(I)-mediated inhibition of cathepsin B through ligand substitutions. Journal of Inorganic Biochemistry 102:3, 555-563
   CrossRef

5. 5

   HASSAN VALLY, PHILIP THOMPSON. (2003) Allergic and asthmatic reactions to alcoholic drinks. Addiction Biology 8:1, 3-11
   CrossRef