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Argyria

  • Author: Kamila K Padlewska, MD, PhD; Chief Editor: William D James, MD  more...
 
Updated: Oct 20, 2015
 

Background

Argyria results from prolonged contact with or ingestion of silver salts. Argyria is characterized by gray to gray-black staining of the skin and mucous membranes produced by silver deposition. Silver may be deposited in the skin either from industrial exposure or as a result of medications containing silver salts.

See Clues on the Skin: Acute Poisonings, a Critical Images slideshow, to help diagnose patients based on their dermatologic presentations.

The most common cause of argyria is mechanical impregnation of the skin by small silver particles in workers involved in silver mining, silver refining, silverware and metal alloy manufacturing, metallic films on glass and china, electroplating solutions, and photographic processing. Colloidal silver dietary supplements are marketed widely for cancer, AIDS, diabetes mellitus, and herpetic infections.[1, 2, 3] Cases have followed the prolonged use of silver salts for the irrigation of urethral or nasal mucous membranes, in eye drops, wound dressing, and the excessive use of an oral smoking remedy containing silver acetate.[4, 5]

Argyria has also been attributed to surgical and dental procedures (eg, silver amalgam-tattooing, silver sutures used in abdominal surgery). Blue macules have appeared at sites of acupuncture needles and silver earring sites.[6, 7] Great individual variability exists in the length of exposure and total dose needed to result in argyria.

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Pathophysiology

Localized argyria occurs in the conjunctiva or oral mucous membrane after long-term topical treatment with silver salt solutions or short-contact acupuncture.

Universal argyria can develop after long-term systemic treatment with drugs that contain silver salts. This used to occur in patients who had taken silver protein suspension for chronic gastritis or gastric ulcer or as nose drops.[8] Argyria also happens as an occupational disease in workers who prepare artificial pearls or who are employed in the cutting and polishing of silver (absorption of silver dust).

The normal human body contains approximately 1 mg of silver; the smallest amount of silver reported to produce generalized argyria in humans ranges from 4-5 g to 20-40 g. Silver at 50-500 mg/kg body weight is the lethal toxic dose in humans.

Bianchi et al report a possible genetic predisposition for argyria.[9]

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Epidemiology

US frequency

Argyria has become a rare dermatosis, mainly because of the avoidance of silver-containing compounds as medicinals and a decrease in occupational exposure in the silver industry. Exposure to silver was common in the early part of this century. The famous Blue Man, a member of the Barnum and Bailey Circus sideshow, had a classic case of argyria.

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Contributor Information and Disclosures
Author

Kamila K Padlewska, MD, PhD Professor, Warsaw Academy of Cosmetics and Health Care; Chief Executive, Cosmetic-Medical Cooperative Izis, Poland

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Smeena Khan, MD Private Practice, Adult and Pediatric Dermatology Associates

Smeena Khan, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

References
  1. Bouts BA. Images in clinical medicine. Argyria. N Engl J Med. 1999 May 20. 340(20):1554. [Medline].

  2. Fung MC, Bowen DL. Silver products for medical indications: risk-benefit assessment. J Toxicol Clin Toxicol. 1996. 34(1):119-26. [Medline].

  3. Gulbranson SH, Hud JA, Hansen RC. Argyria following the use of dietary supplements containing colloidal silver protein. Cutis. 2000 Nov. 66(5):373-4. [Medline].

  4. Brandt D, Park B, Hoang M, Jacobe HT. Argyria secondary to ingestion of homemade silver solution. J Am Acad Dermatol. 2005 Aug. 53(2 Suppl 1):S105-7. [Medline].

  5. Gaslin MT, Rubin C, Pribitkin EA. Silver nasal sprays: misleading Internet marketing. Ear Nose Throat J. 2008 Apr. 87(4):217-20. [Medline].

  6. Legat FJ, Goessler W, Schlagenhaufen C, Soyer HP. Argyria after short-contact acupuncture. Lancet. 1998 Jul 18. 352(9123):241. [Medline].

  7. Rackoff EM, Benbenisty KM, Maize JC, Maize JC Jr. Localized cutaneous argyria from an acupuncture needle clinically concerning for metastatic melanoma. Cutis. 2007 Nov. 80(5):423-6. [Medline].

  8. Prescott RJ, Wells S. Systemic argyria. J Clin Pathol. 1994 Jun. 47(6):556-7. [Medline].

  9. Bianchi L, Orlandi A, Di Stefani A, Ricci R, Chimenti S. "Familial" generalized argyria. Arch Dermatol. 2006 Jun. 142(6):789-90. [Medline].

  10. Menaguale G, Fazio R, Fazio M. Argyria: a case following the prolonged use of a rhinologic drug. Esper Dermatol (Roma). 2003. 4:299-303.

  11. Fisher NM, Marsh E, Lazova R. Scar-localized argyria secondary to silver sulfadiazine cream. J Am Acad Dermatol. 2003 Oct. 49(4):730-2. [Medline].

  12. Shelley WB, Shelley ED, Burmeister V. Argyria: the intradermal "photograph," a manifestation of passive photosensitivity. J Am Acad Dermatol. 1987 Jan. 16(1 Pt 2):211-7. [Medline].

  13. Alés-Fernández M, Ríos-Martín JJ, Camacho-Martínez FM. Localized argyria secondary to acupuncture mimicking blue nevus. J Drugs Dermatol. August 2010. 9(8):1019-20. [Medline].

  14. Enei ML, Paschoal FM, Valdés R. Argyria mimicking a blue nevis: dermoscopy features. An Bras Dermatol. 2013 Jun. 88(3):[Medline].

  15. Graham SA, O'Meara JM. The feasibility of measuring silver concentrations in vivo with x-ray fluorescence. Phys Med Biol. 2004 Aug 7. 49(15):N259-66. [Medline].

  16. Lee SM, Lee SH. Generalized argyria after habitual use of AgNO3. J Dermatol. 1994 Jan. 21(1):50-3. [Medline].

  17. Robinson-Bostom L, Pomerantz D, Wilkel C, et al. Localized argyria with pseudo-ochronosis. J Am Acad Dermatol. 2002 Feb. 46(2):222-7. [Medline].

  18. Sato S, Sueki H, Nishijima A. Two unusual cases of argyria: the application of an improved tissue processing method for X-ray microanalysis of selenium and sulphur in silver-laden granules. Br J Dermatol. 1999 Jan. 140(1):158-63. [Medline].

  19. Rhee DY, Chang SE, Lee MW, Choi JH, Moon KC, Koh JK. Treatment of argyria after colloidal silver ingestion using Q-switched 1,064-nm Nd:YAG laser. Dermatol Surg. 2008 Oct. 34(10):1427-30. [Medline].

  20. Han TY, Chang HS, Lee HK, Son SJ. Successful treatment of argyria using a low-fluence Q-switched 1064-nm Nd:YAG laser. Int J Dermatol. June 2011. 50(6):751-3. [Medline]. [Full Text].

  21. Gorayski P, Pinkham MB, Muir JB, Pullar AP. Severe acute radiation dermatitis in a patient with argyria. Case Rep Oncol Med. 2014. [Medline].

 
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