Gold compounds have long been known as therapeutic agents and have been used extensively in the treatment of rheumatoid arthritis. Their mechanisms of action in vivo, however, remain unclear. In comparison to parenteral gold, the pharmacokinetics of a newly available oral compound, auranofin, differ greatly. Auranofin also appears to have specific immunomodulatory actions and to be associated with fewer and milder toxic effects. The role of chrysotherapy in dermatology has been reemphasized recently. It may be used as an adjuvant in pemphigus or other steroid-responsive diseases to help control disease activity and to taper or eliminate corticosteroid therapy more rapidly. Reports on the use of gold in dermatology are otherwise limited. They include one case of epidermolysis bullosa acquisita and psoriatic arthritis. The benefits of gold treatment have to be weighed against the risks inherent in its adverse reactions, some of which are serious and unpredictable.