A case of generalized argyria after ingestion of colloidal silver solution

Abstract

A 58-year-old woman was referred to our hospital due to progressive skin darkening, which began 5 months previously. The patient had strikingly diffuse blue-gray discoloration of the skin, most prominent in sun-exposed areas, especially her face and hands. The oral mucosa, tongue, gums, eye conjunctiva, ears, nail beds, and trunk were also involved. Bluish-gray discoloration of all nails was aggravated by cold weather. She had ingested 1 L of colloidal silver solution daily for approximately 16 months as a traditional remedy. Her serum silver concentration was 381 ng/ml which was a very high (reference level: <15 ng/ml). Light microscopic examination of a punch biopsy specimen from her nose revealed fine, minute, round, and brown-black granules deposited in the basement membrane of hair follicular epithelium. Scanning electron microscopic examination showed electron-dense granules deposited in the intercellular space of sweat glands. Energy disperse X-ray spectrometry analysis demonstrated peaks for silver and sulfur in the dense black deposits. The ingestion of colloidal silver appears to be an increasing practice among patients using alternative health practices. All silver-containing products including colloidal silver should be labeled with a clear warning to prevent argyria, especially in alternative health practices.

Silver in medicine: The basic science

“…Baker et al reported an 11-year old boy with skin discoloration following ingestion of colloidal silver as an alternativemedicine therapy to facilitate mucus clearance for cystic fibrosis [85]. Kim et al reported a case of diffuse blue-gray skin discoloration in a women who ingested 1 L of colloidal silver solution daily for 16 months as a traditional remedy [86]. Toth et al reported facial argyria in a vegetarian patient who had ingested colloidal silver for two years to stimulate his immune system [87].…”

Environmental Chemistry of Silver in Soils

“…In all terrestrial animals, Ag will partition to the liver and skin, but there are no serious medical consequences (Emsley, 2001). There have been several cases recently in which angyria was diagnosed after consumption of dietary supplements containing colloidal Ag recommended by alternative health groups (Brandt et al, 2005;Chang et al, 2006;Kim et al, 2009;White et al, 2003). Colloidal Ag is sold as a "cure-all" food supplement and is not classified as a medicine, but as a dietary supplement; therefore, it is unregulated by the United States Food and Drug Administration (White et al, 2003).…”

“…In cases of human overexposure to Ag, a skin condition called argyria may result. This condition can cause areas of the skin to produce a grayish-blue coloration, resulting from Ag granules depositing in the skin (Kim et al, 2009). In all terrestrial animals, Ag will partition to the liver and skin, but there are no serious medical consequences (Emsley, 2001).…”

Chromonychia in an Asymptomatic Vitamin Consumer

“…The differential diagnosis includes gray nail pigmentation due to cyanosis, or methemoglobinemia, azure lunulae of Wilson's disease (hepatolenticular degeneration) and blue discoloration due to medications such as minocycline, quinacrine hydrochloride, phenolphthalein and local mercury application [2,3,4]. The key to the diagnosis is the patient's stating of her long-term silver supplement use, coupled with the classic physical findings of the nails.…”

“…The appearance of a bluish-gray discoloration following the distal margin of the lunulae can be an early sign of argyria, along with similar discoloration of the hands and face, especially the conjunctivae [1]. The discoloration is most prominent in sun-exposed areas, as the silver compounds upregulate melanin production, and sunlight catalyzes the reduction of the colorless silver compounds in the dermis to elemental silver, which is then oxidized and bound to form the metallic silver sulfide [2]. …”