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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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Abstract
ABSTRACT A case of localized argyria in a 36-year-old female jeweler is described who presented with 2 discrete and asymptomatic bluish-black pigmented macules on the pulp of her left middle finger. A skin biopsy from both lesions demonstrated deposition of brown/black pigmented granules along the basement membrane zone of eccrine glands, blood vessels, nerves, and the dermo-epidermal junction fully in keeping with silver deposition. In addition, there was yellow-brown deposition seen within the interstitial dermis mimicking an early form of ochronosis, so called "pseudo-ochronosis." This latter feature is rarely described in cases of argyria. Transmission electron microscopy and energy dispersive x-ray spectroscopy confirmed the presence of electron dense particles up to 150 nm in diameter and the presence of silver, respectively. On further questioning, the patient had a history of localized and chronic exposure to silver, which specifically involved holding and manipulating silver wires and rings over the left middle finger. This case highlights an unusual and rare presentation of localized argyria in a jeweler. In addition, our case showed preferential silver deposition on dermal elastic fibers which has not been previously described in the literature.
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Ondrasik RM, Jordan P, Sriharan A. A clinical mimicker of melanoma with distinctive histopathology: Topical silver nitrate exposure. J Cutan Pathol 2020; 47:1205-1210. [PMID: 32803880 DOI: 10.1111/cup.13851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/12/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Abstract
Exposure to silver-containing compounds can result in reversible discoloration of the skin, presenting as an irregular brown or black macule, which can have a clinical appearance similar to melanoma. Both the clinical scenario and the histopathology are unique. Silver nitrate darkens with exposure to light, and the area can appear to change over time. On microscopic examination, there are coarse pigmented granules dispersed throughout the corneal layer, and largely absent from the remainder of the epidermis-although the precise location may depend on the duration of topical exposure. While argyria, its irreversible counterpart, has been well-characterized, only a single source has previously reported the histopathology of transient topical silver nitrate exposure. We present two cases, review the clinical and histopathologic differentials, and detail the distinctive histopathology that enables a diagnosis to be suggested in this clinical mimicker of melanoma.
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Affiliation(s)
- Regina M Ondrasik
- Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, Lebanon, New Hampshire, USA
| | - Parisa Jordan
- Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, Lebanon, New Hampshire, USA
| | - Aravindhan Sriharan
- Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, Lebanon, New Hampshire, USA
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Simon M, Buchanan JA. Argyria, an Unexpected Case of Skin Discoloration From Colloidal Silver Salt Ingestion. J Emerg Med 2020; 59:e39-e41. [PMID: 32591303 DOI: 10.1016/j.jemermed.2020.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Argyria is a rare condition characterized by gray/blue dislocation of the skin caused by chronic exposure to silver salts. CASE REPORT We review the case of an 81-year-old man who presented to the emergency department after a motor vehicle accident, was incidentally found to have skin discoloration, and was ultimately diagnosed with argyria. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although most emergency physicians will not complete a toxicology fellowship, all emergency physicians are on the front line of toxicological presentations and should be able to recognize argyria and differentiate this condition from other causes of skin discoloration.
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Affiliation(s)
- Mark Simon
- Department of Emergency Medicine, Denver Health, Denver, Colorado
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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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Park MY, Lee JS, Jin HJ, You HS, Kim GW, Ko HC, Kim BS, Kim MB, Kim HS. Localized argyria: troublesome side-effect of acupuncture. J Eur Acad Dermatol Venereol 2017; 32:e62-e65. [PMID: 28833654 DOI: 10.1111/jdv.14526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Y Park
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - J S Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Gyeongbuk, Korea
| | - H J Jin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - H S You
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - G W Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - H C Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - B S Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - M B Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - H S Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Wootton CI, May T, Khan M, Walker SL. A pigmented lesion on the earlobe. Clin Exp Dermatol 2014; 40:457-9. [PMID: 25476801 DOI: 10.1111/ced.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
- C I Wootton
- Dermatology Department, Queens Medical Centre, Nottinghamm, UK
| | - T May
- University of Nottingham, Nottingham, UK
| | - M Khan
- Histopathology Department, Queens Medical Centre, Nottingham, UK
| | - S L Walker
- Dermatology Department, Circle NHS Treatment Centre, Nottingham, UK
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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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Hristov AC, High WA, Golitz LE. Localized cutaneous argyria. J Am Acad Dermatol 2011; 65:660-661. [PMID: 21839327 DOI: 10.1016/j.jaad.2010.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 05/05/2010] [Accepted: 05/06/2010] [Indexed: 11/15/2022]
Affiliation(s)
- Alexandra C Hristov
- Department of Pathology, The University of Colorado Health Sciences Center, Aurora, Colorado
| | - Whitney A High
- Department of Dermatology, The University of Colorado Health Sciences Center, Aurora, Colorado
| | - Loren E Golitz
- Department of Pathology, The University of Colorado Health Sciences Center, Aurora, Colorado.
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Cahn V, Antunes L, Ounnoughène-Piet M, Royer C, Georges JL, Plénat F. [An abnormal pigmentation of the upper eyelid]. Ann Pathol 2004; 24:199-200. [PMID: 15220844 DOI: 10.1016/s0242-6498(04)93948-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Virginie Cahn
- Service d'Anatomie et Cytologie Pathologiques, CHU Brabois, Vandoueuvre lès Nancy
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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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