argyriaArgyria is a rare condition of silver deposition in human body caused by the excessive intake of silver-containing medications or occupational exposure to silver salts or silver dust that could be chronic or acute.

Argyria is a rare dermatosis characterized by the blue-grey to gray-black skin color, discoloration of fingernails and mucous membranes.  Deposits of silver may be localized or systemic. The skin color change is more evident on the areas of the skin exposed to the sunlight.
The famous Blue Man, a member of the Barnum and Bailey Circus sideshow, had suffered on argyria.

The main cause of argyria is an intake of silver-containing medications (especially silver colloids) or exposure to silver salts or silver dust. Mechanical impregnation of the skin causes discoloration of the skin and mucosa, the deposits of silver in the internal organs are also present. Normally in human body there is approximately 1 mg of silver, argyria develops when the amount of silver in the body is around 4-40 g. It is estimated that silver’s lethal dose for the humans is 50-500 mg/kg body weight.

Risk factors
The condition occurs among the workers in the heavy metal industry (for example silver refining, mining or metal alloy manufacture). Exposure to silver-containing components and dust is also common in other occupations such as photographic processing, adding metallic film on china and glassware. These professionals are usually exposed to silver.
Some of the medications and dietary supplements used for the treatment of AIDS, cancer, cystic fibrosis, herpes-virus infection are also known to contain silver particles. There were reported several cases of the development of argyria due to the usage of silver-containing nose or eye-drops. Some of the wound dressings used in dental and surgical procedures contain silver salts (Aquacel, Acticoat etc.) and can cause localized or even systemic argyria.
Some people use silver acetate during smoking quitting. Excessive intake of this salt can lead to argyria, especially of the mouth mucosa.
Silver amalgam used for tattooing, acupuncture needles and silver earrings can also cause silver deposition.
In some cases the condition develops after the long period of silver exposure, in others – after the short terms. The susceptibility to silver is predisposed genetically and depends on the personal features.

The initial symptoms of systemic argyria include the excretion of silver with body’s fluids (urine, sweat), although this symptom is usually missed. Excess of silver in the body surpasses the body’s renal and hepatic excretory capacities, this leads to deposition of silver in granules in the skin and its appendages, mucous membranes and internal organs (kidneys, spleen, bone marrow, eyes).  The first visible deposits of silver can be found in and under fingernails. They become bluish or grey. Skin appears blue, blue-grey or dark-grey, it can be affected completely or have only some patches of pigmentation.
Usually there are no other significant health considerations; the only problem that bothers patients is a cosmetic defect. Some reports suggest kidney failure and loss of night vision as a complication of the disease.

Levels of silver can be measured in blood or urine. The best way to confirm the diagnosis is a skin biopsy.
Systemic argyria requires blood count, estimation of renal and hepatic function, blood glucose level to make sure that the internal organs function normally.

The condition is incurable, although several cosmetic surgeries and bleaching agents (5% hydroquinone) were proposed. Sulfur and selenium compounds are known to decrease silver levels in organism and its toxicity.
Surgery with the Nd:YAG laser has been implemented, but there was no significant benefit reported. Laser-assisted surgeries may cause complication and lead even to the worse discoloration of the skin. These surgeries are not recommended for the treatment of the large skin areas, because they are extremely painful.
Patients are suggested to avoid direct sunlight and use of sunscreen, as long as exposure to the sunlight worsens the state of the skin.

Related: Russell-Silver syndrome


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