Clinical and Forensic Aspects of the Different Subtypes of Argyria

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.

A case of argyria as consequence of alternative medical treatment

“…nanoparticles in the basal lamina of the secretory part of the eccrine glands, the blood vessel walls, and the elastic fibers of the dermis (Figure 2), as described in literature; 1,5,6 confirming our suspected diagnosis.…”

“…A 4 mm punch biopsy from the left lateral periorbital area was performed. Histological examination revealed deposits of silver nanoparticles in the basal lamina of the secretory part of the eccrine glands, the blood vessel walls, and the elastic fibers of the dermis (Figure 2 ), as described in literature; 1 , 5 , 6 confirming our suspected diagnosis.…”

A case of argyria as consequence of alternative medical treatment

“…nanoparticles in the basal lamina of the secretory part of the eccrine glands, the blood vessel walls, and the elastic fibers of the dermis (Figure 2), as described in literature; 1,5,6 confirming our suspected diagnosis.…”

“…A 4 mm punch biopsy from the left lateral periorbital area was performed. Histological examination revealed deposits of silver nanoparticles in the basal lamina of the secretory part of the eccrine glands, the blood vessel walls, and the elastic fibers of the dermis (Figure 2 ), as described in literature; 1 , 5 , 6 confirming our suspected diagnosis.…”

A patient with blue‐gray pigmentation of the skin

“…In addition to the deposits, silver also stimulates melanin production by activating tyrosinase activity, further intensifying skin pigmentation. [1][2][3][4] Silver deposits are located in the dermis and accentuated around glandular structures, particularly at the basement membranes of sweat glands. Deposits can also be found in elastic fibers of the papillary dermis, and to a lesser extent in the fibrinous hair root sheaths of arrector pili muscles and small arteriole walls.…”

“…Deposits can also be found in elastic fibers of the papillary dermis, and to a lesser extent in the fibrinous hair root sheaths of arrector pili muscles and small arteriole walls. [2][3][4] Argyria is a rare clinical diagnosis. Differential diagnoses for hyperpigmentation include metabolic disorders such as Addison's disease, drug-induced pigmentation (for example caused by amiodarone 5 ), and other deposition dermatoses such as chrysiasis (Table 1).…”

“…Differential diagnoses for hyperpigmentation include metabolic disorders such as Addison's disease, drug-induced pigmentation (for example caused by amiodarone 5 ), and other deposition dermatoses such as chrysiasis (Table 1). 2,4 A key diagnostic clue is a history of consuming silver-containing substances. Systemic silver compounds are not used in modern evidence-based medicine but are still recommended by alternative health practitioners and are available over the counter online.…”

A case of argyria as consequence of alternative medical treatment

“…nanoparticles in the basal lamina of the secretory part of the eccrine glands, the blood vessel walls, and the elastic fibers of the dermis (Figure 2), as described in literature; 1,5,6 confirming our suspected diagnosis.…”

“…A 4 mm punch biopsy from the left lateral periorbital area was performed. Histological examination revealed deposits of silver nanoparticles in the basal lamina of the secretory part of the eccrine glands, the blood vessel walls, and the elastic fibers of the dermis (Figure 2 ), as described in literature; 1 , 5 , 6 confirming our suspected diagnosis.…”

A patient with blue‐gray pigmentation of the skin

“…In addition to the deposits, silver also stimulates melanin production by activating tyrosinase activity, further intensifying skin pigmentation. [1][2][3][4] Silver deposits are located in the dermis and accentuated around glandular structures, particularly at the basement membranes of sweat glands. Deposits can also be found in elastic fibers of the papillary dermis, and to a lesser extent in the fibrinous hair root sheaths of arrector pili muscles and small arteriole walls.…”

“…Deposits can also be found in elastic fibers of the papillary dermis, and to a lesser extent in the fibrinous hair root sheaths of arrector pili muscles and small arteriole walls. [2][3][4] Argyria is a rare clinical diagnosis. Differential diagnoses for hyperpigmentation include metabolic disorders such as Addison's disease, drug-induced pigmentation (for example caused by amiodarone 5 ), and other deposition dermatoses such as chrysiasis (Table 1).…”

“…Differential diagnoses for hyperpigmentation include metabolic disorders such as Addison's disease, drug-induced pigmentation (for example caused by amiodarone 5 ), and other deposition dermatoses such as chrysiasis (Table 1). 2,4 A key diagnostic clue is a history of consuming silver-containing substances. Systemic silver compounds are not used in modern evidence-based medicine but are still recommended by alternative health practitioners and are available over the counter online.…”

A case of argyria as consequence of alternative medical treatment

“…nanoparticles in the basal lamina of the secretory part of the eccrine glands, the blood vessel walls, and the elastic fibers of the dermis (Figure 2), as described in literature; 1,5,6 confirming our suspected diagnosis.…”

“…A 4 mm punch biopsy from the left lateral periorbital area was performed. Histological examination revealed deposits of silver nanoparticles in the basal lamina of the secretory part of the eccrine glands, the blood vessel walls, and the elastic fibers of the dermis (Figure 2 ), as described in literature; 1 , 5 , 6 confirming our suspected diagnosis.…”

A patient with blue‐gray pigmentation of the skin

“…In addition to the deposits, silver also stimulates melanin production by activating tyrosinase activity, further intensifying skin pigmentation. [1][2][3][4] Silver deposits are located in the dermis and accentuated around glandular structures, particularly at the basement membranes of sweat glands. Deposits can also be found in elastic fibers of the papillary dermis, and to a lesser extent in the fibrinous hair root sheaths of arrector pili muscles and small arteriole walls.…”

“…Deposits can also be found in elastic fibers of the papillary dermis, and to a lesser extent in the fibrinous hair root sheaths of arrector pili muscles and small arteriole walls. [2][3][4] Argyria is a rare clinical diagnosis. Differential diagnoses for hyperpigmentation include metabolic disorders such as Addison's disease, drug-induced pigmentation (for example caused by amiodarone 5 ), and other deposition dermatoses such as chrysiasis (Table 1).…”

“…Differential diagnoses for hyperpigmentation include metabolic disorders such as Addison's disease, drug-induced pigmentation (for example caused by amiodarone 5 ), and other deposition dermatoses such as chrysiasis (Table 1). 2,4 A key diagnostic clue is a history of consuming silver-containing substances. Systemic silver compounds are not used in modern evidence-based medicine but are still recommended by alternative health practitioners and are available over the counter online.…”