Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Argyria Workup

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

Imaging Studies

In vivo silver concentrations can be measured using x-ray fluorescence.[15]

Next

Procedures

The diagnosis of argyria is established by skin biopsy with formaldehyde-fixed paraffin-embedded sections stained with hematoxylin-eosin.

Previous
Next

Histologic Findings

Small, round, brown-black granules appear singly or in clusters and are evident with routine staining. They spare both the epidermis and its appendages, appearing in greatest numbers in the basement membrane zone surrounding sweat glands. These silver granules also favor the connective-tissue sheaths around pilosebaceous structures and nerves. They have a predilection for elastic fibers and are best visualized as strikingly refractile with dark-field illumination. An increase in the amount of melanin in exposed skin also appears to occur.

Electron microscopy demonstrates electron-dense granules. In early cases, they are located within fibroblasts and macrophages, while later most are present extracellularly. Neutron activation analysis, atomic absorption spectrophotometry, or x-ray dispersive microanalysis can be used to confirm that the granules contain silver and often also sulfur and less commonly selenium.[16, 17, 18] A simpler option is to decolorize the silver by placing histologic sections into 1% potassium ferricyanide in 20% sodium thiosulfate.

Previous
 
 
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].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.