Argyria 

  • Author: Kamila K Padlewska, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 15, 2011
 

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.

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

Frequency

United States

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, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

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, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

  1. Bouts BA. Images in clinical medicine. Argyria. N Engl J Med. May 20 1999;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. Nov 2000;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. Aug 2005;53(2 Suppl 1):S105-7. [Medline].

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

  6. Legat FJ, Goessler W, Schlagenhaufen C, Soyer HP. Argyria after short-contact acupuncture. Lancet. Jul 18 1998;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. Nov 2007;80(5):423-6. [Medline].

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

  9. Bianchi L, Orlandi A, Di Stefani A, Ricci R, Chimenti S. "Familial" generalized argyria. Arch Dermatol. Jun 2006;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. Oct 2003;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. Jan 1987;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. Graham SA, O'Meara JM. The feasibility of measuring silver concentrations in vivo with x-ray fluorescence. Phys Med Biol. Aug 7 2004;49(15):N259-66. [Medline].

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

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

  17. 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. Jan 1999;140(1):158-63. [Medline].

  18. 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. Oct 2008;34(10):1427-30. [Medline].

  19. 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].

 
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