Diagnostic Considerations

Also consider the following:

Medications (ie, phenothiazines, antimalarials, amiodarone, minocycline)
Hemochromatosis
Polycythemia vera
Addison disease
Diffuse melanosis in metastatic melanoma
Heavy metals (ie, mercury, bismuth, arsenic, gold, lead)
Central cyanosis (impaired pulmonary function, anatomic shunt, hemoglobin abnormalities, methemoglobinemia)
Peripheral cyanosis (reduced cardiac output)
Blue nevus ^{[15, 16]}

Argyria may produce a yellow-brown deposition within the dermis that may need to be to distinguished from early ochronosis.^[17]

Localized cutaneous argyria may resemble and need to be distinguished from melanocytic lesions.^[18]

Differential Diagnoses

Ochronosis and Alkaptonuria

Workup

Bouts BA. Images in clinical medicine. Argyria. N Engl J Med. 1999 May 20. 340(20):1554. [QxMD MEDLINE Link].
Fung MC, Bowen DL. Silver products for medical indications: risk-benefit assessment. J Toxicol Clin Toxicol. 1996. 34(1):119-26. [QxMD MEDLINE Link].
Gulbranson SH, Hud JA, Hansen RC. Argyria following the use of dietary supplements containing colloidal silver protein. Cutis. 2000 Nov. 66(5):373-4. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Gaslin MT, Rubin C, Pribitkin EA. Silver nasal sprays: misleading Internet marketing. Ear Nose Throat J. 2008 Apr. 87(4):217-20. [QxMD MEDLINE Link].
Denes E, El Balkhi S, Fiorenza F. Local Argyria due to Silver-Coated Megaprosthesis. Am J Med. 2022 Feb 5. [QxMD MEDLINE Link]. [Full Text].
Legat FJ, Goessler W, Schlagenhaufen C, Soyer HP. Argyria after short-contact acupuncture. Lancet. 1998 Jul 18. 352(9123):241. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Prescott RJ, Wells S. Systemic argyria. J Clin Pathol. 1994 Jun. 47(6):556-7. [QxMD MEDLINE Link].
Bianchi L, Orlandi A, Di Stefani A, Ricci R, Chimenti S. "Familial" generalized argyria. Arch Dermatol. 2006 Jun. 142(6):789-90. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Menaguale G, Fazio R, Fazio M. Argyria: a case following the prolonged use of a rhinologic drug. Esper Dermatol (Roma). 2003. 4:299-303.
Fisher NM, Marsh E, Lazova R. Scar-localized argyria secondary to silver sulfadiazine cream. J Am Acad Dermatol. 2003 Oct. 49(4):730-2. [QxMD MEDLINE Link].
Gorayski P, Pinkham MB, Muir JB, Pullar AP. Severe acute radiation dermatitis in a patient with argyria. Case Rep Oncol Med. 2014. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Enei ML, Paschoal FM, Valdés R. Argyria mimicking a blue nevis: dermoscopy features. An Bras Dermatol. 2013 Jun. 88(3):[QxMD MEDLINE Link].
Georgiadou N, Singh S, Wagner B, et al. Occupational Localized Cutaneous Argyria With Pseudo-Ochronosis in a Jeweler. Am J Dermatopathol. 2021 Nov 1. 43 (11):822-826. [QxMD MEDLINE Link].
Gill P, Richards K, Cho WC, et al. Localized cutaneous argyria: Review of a rare clinical mimicker of melanocytic lesions. Ann Diagn Pathol. 2021 Oct. 54:151776. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Cinotti E, Labeille B, Douchet C, Cambazard F, Perrot JL. Dermoscopy, reflectance confocal microscopy, and high-definition optical coherence tomography in the diagnosis of generalized argyria. J Am Acad Dermatol. 2017 Feb. 76 (2S1):S66-S68. [QxMD MEDLINE Link].
García-Martínez P, López Aventín D, Segura S, Gómez-Martín I, Lloreta J, Ibáñez J, et al. In vivo reflectance confocal microscopy characterization of silver deposits in localized cutaneous argyria. Br J Dermatol. 2016 Nov. 175 (5):1052-1055. [QxMD MEDLINE Link].
Sarnat-Kucharczyk M, Pojda-Wilczek D, Mrukwa-Kominek E. Diagnostic methods in ocular argyrosis: case report. Doc Ophthalmol. 2016 Oct. 133 (2):129-138. [QxMD MEDLINE Link].
Lee SM, Lee SH. Generalized argyria after habitual use of AgNO3. J Dermatol. 1994 Jan. 21(1):50-3. [QxMD MEDLINE Link].
Robinson-Bostom L, Pomerantz D, Wilkel C, et al. Localized argyria with pseudo-ochronosis. J Am Acad Dermatol. 2002 Feb. 46(2):222-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. 2011 Jun. 50 (6):751-3. [QxMD MEDLINE Link].
Friedmann DP, Buckley S, Mishra V. Localized Cutaneous Argyria From a Nasal Piercing Successfully Treated With a Picosecond 755-nm Q-Switched Alexandrite Laser. Dermatol Surg. 2017 Aug. 43 (8):1094-1095. [QxMD MEDLINE Link].
DiGiorgio CM, Wu DC, Goldman MP. Successful Treatment of Argyria Using the Picosecond Alexandrite Laser. Dermatol Surg. 2016 Mar. 42 (3):431-3. [QxMD MEDLINE Link].

Media Gallery

A 92-year-old asymptomatic white man with generalized argyria. For many years, this man had used nose drops containing silver. His skin biopsy showed silver deposits in the dermis, confirming the diagnosis of argyria. © Dec 3, 2008 Herbert L. Fred, MD; Hendrik A. van Dijk. Textbook content produced by Herbert L. Fred, MD; Hendrik A. van Dijk is licensed under a Creative Commons Attribution License 2.0 license.

of 1

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, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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.