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Clinical and Forensic Aspects of the Different Subtypes of Argyria. J Clin Med 2021; 10:jcm10102086. [PMID: 34068024 PMCID: PMC8152497 DOI: 10.3390/jcm10102086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
Argyria encompasses the different cosmetic alterations that can develop if enough silver particles deposit in a specific tissue, typically in the skin, ranging from localized dark-blue macules to a generalized slate-gray/bluish tinge following systemic absorption. This work aims to fully review the state of the art regarding pathophysiology, diagnosis, treatment, and relevant clinical and forensic features of argyria. Argyria has been diagnosed in a wide range of ages, both sexes and varied ethnicities, with no known individual predisposing factors. Ultraviolet radiation with subsequence increases of melanin production aggravates the discoloration due to a reduction in the silver deposits. Physical examination and silver exposure in the anamnesis can be highly suggestive of the diagnosis, but a histopathological analysis with Energy-Dispersive X-ray Spectroscopy is required to unequivocally determine the discoloration etiology. Safe and effective treatment has only been accomplished with laser techniques, though only a few cases have been reported and with limited follow-up time. In conclusion, argyria typically has an occupational or iatrogenic etiology. It should be suspected when a patient presents with typical skin or eye lesions. A seemingly viable treatment modality, with laser technology, is finally within the horizon.
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Arunkajohnsak S, Thanomkitti K, Kasemsarn P, Pattanaprichakul P, Jiamton S, Eimpunth S. Successful treatment of acupuncture-induced argyria using Q-switched 1064-nm Nd:YAG laser. JAAD Case Rep 2020; 6:984-987. [PMID: 32995425 PMCID: PMC7508910 DOI: 10.1016/j.jdcr.2020.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Kanchalit Thanomkitti
- Correspondence to: Kanchalit Thanomkitti, MD, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkoknoi, Bangkok 10700, Thailand.
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Hadrup N, Sharma AK, Loeschner K. Toxicity of silver ions, metallic silver, and silver nanoparticle materials after in vivo dermal and mucosal surface exposure: A review. Regul Toxicol Pharmacol 2018; 98:257-267. [DOI: 10.1016/j.yrtph.2018.08.007] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/30/2022]
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Jung I, Joo EJ, Suh BS, Ham CB, Han JM, Kim YG, Yeom JS, Choi JY, Park JH. A case of generalized argyria presenting with muscle weakness. Ann Occup Environ Med 2017; 29:45. [PMID: 29026613 PMCID: PMC5625662 DOI: 10.1186/s40557-017-0201-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 09/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background Argyria is a rare irreversible cutaneous pigmentation disorder caused by prolonged exposure to silver. Herein, we report a case of generalized argyria that developed after chronic ingestion of soluble silver-nano particles and presented with muscle weakness. Case presentation A 74-year-old woman visited our emergency room, complaining of fever and mental deterioration. She was diagnosed with acute pyelonephritis and recovered after antibiotic therapy. At presentation, diffuse slate gray-bluish pigmented patches were noticed on her face and nails. Two months prior to visiting our hospital, she was diagnosed with inflammatory myopathy and given steroid therapy at another hospital. We performed a nerve conduction study that revealed polyneuropathy. In skin biopsies from pigmented areas of the forehead and nose, the histopathologic results showed brown-black granules in basement membranes of sweat gland epithelia, which are diagnostic findings of argyria. We reviewed pathology slides obtained from the left thigh muscles and found markedly degenerated myofibers with disorganization of myofibrils without inflammatory reactions, consistent with unspecified myopathy, rather than inflammatory myopathy. The patient was diagnosed with generalized argyria with polyneuropathy and myopathy and transferred to a rehabilitation institution after being tapered off of steroids. Conclusions Clinicians should be aware of clinical manifestations of argyria and consider it in differential diagnosis when they examine patients who present with skin pigmentation and muscle weakness.
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Affiliation(s)
- Inha Jung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - Eun-Jeong Joo
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - Byung Seong Suh
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Cheol-Bae Ham
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - Ji-Min Han
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - You-Gyung Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - Ju-Yeon Choi
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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García-Martínez P, López Aventín D, Segura S, Gómez-Martín I, Lloreta J, Ibáñez J, Elvira JJ, Pujol RM. In vivo reflectance confocal microscopy characterization of silver deposits in localized cutaneous argyria. Br J Dermatol 2016; 175:1052-1055. [PMID: 26997486 DOI: 10.1111/bjd.14571] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/27/2022]
Abstract
Localized cutaneous argyria is a rare condition secondary to skin deposition of silver following exposure to substances containing this metal. The clinical appearance and dermoscopy findings require deep melanocytic lesions and particularly melanoma metastasis to be ruled out. Silver deposits are usually confirmed by scanning electron microscopy and/or energy-dispersive X-ray spectroscopy. Herein we describe the in vivo reflectance confocal microscopy (RCM) features observed in one case of localized cutaneous argyria. These features include the presence of a hyperrefractile network in the papillary dermis and a periadnexal dotted bright pattern. In vivo RCM might be a useful tool for an early diagnosis of this uncommon entity.
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Affiliation(s)
- P García-Martínez
- Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain.
| | - D López Aventín
- Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain
| | - S Segura
- Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain
| | - I Gómez-Martín
- Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain
| | - J Lloreta
- Department of Pathology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain
| | - J Ibáñez
- Institut de Ciències de la Terra Jaume Almera, CSIC, Barcelona, Spain
| | - J J Elvira
- Institut de Ciències de la Terra Jaume Almera, CSIC, Barcelona, Spain
| | - R M Pujol
- Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain
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Abstract
We report 2 cases of patients who presented with blue macules clinically suspicious for blue nevi. One patient had no documented history of trauma or silver exposure, and the other reported exposure to silver over 30 years ago. Microscopic examination revealed a dermal population of brown-black globules predominantly adhering to collagen fibers. In both cases, no melanocytic proliferation was identified by immunohistochemistry. Analysis of the skin biopsies with scanning electron microscopy and energy dispersive x-ray spectroscopy demonstrated the presence of silver and selenium. These findings were diagnostic of localized cutaneous argyria. Our case reports highlight the importance of including localized cutaneous argyria in the differential diagnosis of pigmented lesions.
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Localized Cutaneous Argyria: A Report of 2 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Garcias-Ladaria J, Hernandez-Bel P, Torregrosa-Calatayud JL, Martínez-Aparicio A. Localized cutaneous argyria: a report of 2 cases. ACTAS DERMO-SIFILIOGRAFICAS 2012; 104:253-4. [PMID: 22938996 DOI: 10.1016/j.ad.2012.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/13/2012] [Accepted: 03/18/2012] [Indexed: 11/30/2022] Open
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Sendagorta E, Herranz P, Casado B, Gómez C, Ramírez P, Feito M, García-Cabezas MA. Scattered blue maculae in a patient with albinism. Clin Exp Dermatol 2011; 36:419-20. [DOI: 10.1111/j.1365-2230.2010.03975.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lugasi A. About the toxicity and conditions of use of silver and silver salts. Orv Hetil 2009; 150:1493-6. [DOI: 10.1556/oh.2009.28707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrea Lugasi
- 1 Országos Élelmezés- és Táplálkozástudományi Intézet Budapest Gyáli út 3/A 1097
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Panyala NR, Peña-Méndez EM, Havel J. Silver or silver nanoparticles: a hazardous threat to the environment and human health? J Appl Biomed 2008. [DOI: 10.32725/jab.2008.015] [Citation(s) in RCA: 355] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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White JML, Powell AM, Brady K, Russell-Jones R. Severe generalized argyria secondary to ingestion of colloidal silver protein. Clin Exp Dermatol 2003; 28:254-6. [PMID: 12780705 DOI: 10.1046/j.1365-2230.2003.01214.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Argyria is a rare cause of cutaneous discolouration caused by silver deposition. We report a case of dramatic and diffuse argyria secondary to ingestion of colloidal silver protein over a 1-year period. Stained electron microscopy with spectral analysis was used to confirm the clinical diagnosis. Silver-protein complexes are deposited in the skin and reduced to inert silver salts by sunlight in a process similar to that harnessed in photography. Our patient had obtained the silver for consumption via mail order. It had been advertised as a cure for a variety of diseases. Colloidal silver protein is commercially available as a 'food supplement', hence circumventing the strict controls placed on medicines.
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Affiliation(s)
- J M L White
- Department of Dermatology, Ealing Hospital, London, UK.
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Robinson-Bostom L, Pomerantz D, Wilkel C, Mader R, Lerner L, Dufresne R, Flotte T. Localized argyria with pseudo-ochronosis. J Am Acad Dermatol 2002; 46:222-7. [PMID: 11807434 DOI: 10.1067/mjd.2002.116227] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Localized argyria is uncommon and presents clinically as asymptomatic slate gray macules or blue macules resembling blue nevi. Its histopathologic features are usually similar to those of generalized argyria in which silver granules are found most commonly around the eccrine glands, in the walls of blood vessels, and along elastic fibers. Ochre swollen homogenized collagen bundles resembling ochronosis have not been previously described. OBJECTIVE The purpose of this study is to report a series of 5 patients with localized argyria with the histologic feature of "pseudo-ochronosis." In one patient, biopsy was performed on 2 distinct lesions. METHODS All patients underwent skin biopsies for light microscopy and darkfield microscopy. In two patients, the biopsy specimens were analyzed with a mass spectrophotometer; scanning electron microscopy and energy-dispersive x-ray analysis were performed. In one patient, the biopsy specimen was decolorized with 1% potassium ferricyanide in 20% sodium thiosulfate. RESULTS All 5 patients presented with the typical clinical and histologic features of localized argyria. Ochre swollen and homogenized collagen bundles were seen in all cases. In addition, light microscopy in 4 cases revealed an ellipsoid black globule within a zone of collagen degeneration. CONCLUSION The histologic features of localized argyria include swollen and homogenized collagen bundles resembling ochronosis, "pseudo-ochronosis," which may be more common than previously recognized.
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Affiliation(s)
- Leslie Robinson-Bostom
- Department of Dermatology, Brown University School of Medicine/Rhode Island Hospital, Providence, RI 02903, USA.
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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; 140:158-63. [PMID: 10215789 DOI: 10.1046/j.1365-2133.1999.02628.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Using a simplified tissue processing method for X-ray microanalysis, we have characterized the elemental composition of silver-laden granules deposited in the skin of two patients with argyria. The introduction of ethanol as a fixative and nylon mesh as a supporting grid, and the avoidance of electron staining, have facilitated the minimization of unwanted microanalytical emission peaks generated from conventional chemicals and metals, which often disturb precise clarification of elements of pathological interest in argyria. The two main X-ray microanalytical findings in this study were: (i) the consistent presence of sulphur and the inconsistent occurrence of selenium in the silver-laden granules, and (ii) successful mapping of the distribution of trace amounts of selenium present in argyria. The simplified tissue processing method could be useful in future critical X-ray microanalysis studies.
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Affiliation(s)
- S Sato
- Department of Dermatology, Showa University School of Medicine, Tokyo, Japan
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Abstract
Generalized argyria, the systemic dissemination and tissue deposition of silver-containing particles, is characterized by slate gray discoloration of skin, most pronounced in sun exposed areas. A 33-year-old woman visited our dermatologic clinic complaining of frequent oral ulceration for 10 years and generalized discoloration of her skin for 5 years. She had had her tongue painted with silver nitrate repeatedly 6 years ago for the treatment of oral ulcers. Physical examination showed slate gray discoloration of her skin, most pronounced on the face and neck. The oral mucosa, tongue, sclera, and conjunctiva also had a slightly blue-gray discoloration. Biopsy specimens from the oral mucosa and forearm revealed small brown-black granules scattered in the dermis and basal lamina of eccrine sweat glands, blood vessels, and hair follicles under the light microscope. Tiny black granules were most numerous in the basal laminae of vessels in electron microscopic observation. Energy dispersive X-ray microanalysis (EDXA) confirmed that many of the granules contained silver.
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Affiliation(s)
- S M Lee
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
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