Photodynamic therapy is safe and has the potential to clinically and histologically treat AC, with a need for future randomized controlled trials.

Argyria is a benign skin disease characterized by blue to slate-grey discoloration that is caused by deposition of silver granules in the skin and/or mucus membranes as a result of long-term ingestion of ionized silver solutions or exposure to airborne silver particles. The skin discoloration can be generalized or localized and is exacerbated by sunlight. The skin discoloration is usually permanent, and until recently, there has been no effective treatment for argyria. Over the past 6 years, a number of case reports and one case series have described cases of argyria that were successfully treated with a 1064 nm Q-switched (QS) neodymium-doped yttrium aluminium garnet (Nd:YAG) laser; however, a review of these studies has never been reported in the dermatologic literature. To review the use of the 1064 nm QS Nd:YAG laser for the treatment of argyria. A search of the National Library of Medicine's PubMed Database and the SCOPUS Database was performed to find articles that detailed the treatment of argyria with 1064 nm QS Nd:YAG laser. Six articles were selected for inclusion in this review. Each article was reviewed and summarized in a table. A 1064 nm QS Nd:YAG laser offers a novel and effective treatment for argyria. A systematic review of the dermatologic literature revealed a limited number of case reports and case series using this treatment. However, the results gleaned by the authors from the literature review provide important information to the clinician. For patients with argyria, a single pass of the 1064 nm QS Nd:YAG laser offers immediate, effective and sustained pigment clearing without any long-term adverse effects.

Benign familial chronic pemphigus, or Hailey-Hailey disease (HHD), is a recurrent bullous dermatitis that tends to have a chronic course with frequent relapses. Long-term treatment options include surgery with skin grafting or dermabrasion. Both are highly invasive and carry significant risks and complications. More recently, 'laser-abrasion' has been described as a less invasive option with a better side-effect profile. In this article, we systematically review the safety and efficacy of carbon dioxide laser therapy as a long-term treatment option for HHD, as well as provide a review of other lasers that have been reported with this goal. A total of 23 patients who had been treated with a carbon dioxide laser were identified. After treatment, 10 patients (43%) had had no recurrence, 10 (43%) had greater than 50% improvement, 2 (8%) had less than 50% improvement and 1 (4%) patient had no improvement at all (follow-up period ranged from 4 to 144 months). Laser parameter variability was wide and adverse effects were minimal, including dyspigmentation and scarring. Reviewed evidence indicates this therapy offers a safe, effective treatment alternative for HHD with minimal risk of side-effects. Larger, well-designed studies are necessary to determine the optimal treatment parameters.

The use of silver for medicinal purposes dates back to the eighth century CE and is still in use today.1-3 Generalized argyria is characterized by slate-gray to blue discoloration of the skin caused by cutaneous deposits of silver particles after long-term ingestion of solutions containing colloidal silver ingredients or silver salts. [1][2][3] The skin discoloration is more prominent in sunexposed areas and is usually permanent. There is no widely accepted effective treatment for the skin discoloration of argyria. 4(p44653) Despite the FDA's warning, colloidal silver remains accessible from at least 2 major online retailers and is being marketed as a dietary supplement that will improve health. The product description of one ingestible liquid product containing colloidal silver from Walmart.com claims it can "eliminate toxins, poisons and fungi from your body" and that it will "keep your system's defenses against toxins and viruses high" (both quotations from http://url.ie/ylm7).Methods | To investigate the current availability of colloidal silver solution in one major online marketplace, the term colloidal silver was searched on Amazon.com on June 13, 2014. The search yielded 2286 different colloidal silver products. The products were then limited to only those listed in the health and personal care department, which yielded 1010 different products. The results were then limited to only liquid colloidal silver products, which yielded 149 different products; only these ingestible liquid colloidal silver products were analyzed. The search results were sorted by relevance, not by rating.Results | Twenty-four different ingestible liquid products containing colloidal silver were listed on the first page of the search results; only products on this first page of the results that had at least 10 consumer reviews were included for analysis. These criteria yielded 12 colloidal silver products with a combined total of 606 individual customer reviews (mean, 50.5 reviewers per product). The mean consumer rating of these 12 products was 4.38 of a possible maximum rating of 5 stars.Discussion | The availability of colloidal silver solution as a health and personal care product is concerning. With the use of an online marketplace, colloidal silver can be easily obtained, and consumers can be influenced by the favorable product reviews. It is important that a patient's medical history include information about over-the-counter medications, dietary supplements, and complementary and alternative medications. The most common adverse effect of long-term colloidal silver ingestion is argyria. Advising patients against further use can prevent worsening of skin discoloration and development of renal, hepatic, and neurologic problems that have been reported after long-term ingestion of colloidal silver. 4 In addition, the FDA warning made 16 years ago should be reemphasized and consideration should be given to adding colloidal silver to the list of the agency's Unapproved Drugs Initiative since it poses a potential safety risk an...

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