Iatrogenic Rhinopharyngeal Isolated Argyria Induced by Silver-Containing Nasal Drug

Raimondo, Luca; Garzaro, Massimiliano; Molinaro, Luca; Bartoli, Claudia; Provenzano, Erica; Pecorari, Giancarlo

doi:10.1097/scs.0000000000000416

Cited by 5 publications

(3 citation statements)

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“…Research into the safety profile of CS is limited mainly to animal models and case reports [ 21 ]. Indiscriminant use of silver can cause argyria, which is a permanent blue-grey discoloration of the skin, mucosa or internal organs [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of topical colloidal silver in recalcitrant chronic rhinosinusitis: A randomized crossover control trial

Scott

Krishnan

Rotenberg

et al. 2017

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundRecalcitrant chronic rhinosinusitis without polyposis (CRSsP) is a challenging condition to manage as traditional medical therapies and surgery fail to provide satisfactory clinical improvements. Colloidal silver (CS), a widely used naturopathic agent, has recently shown anti-biofilm properties both in vitro and within a rhinosinusitis animal model. To date, no trials involving humans have been published in world literature. The purpose of this study was to assess the efficacy of CS as a topical nasal spray in patients with refractory CRSsP.MethodsA prospective cohort study was conducted using a convenience sample of 20 randomized patients with crossover methodology, comparing nasal sprays with CS versus saline. Patients sprayed twice daily for six weeks with the first intervention and then switched to the second for the next six weeks, with measurements made at baseline and each time point. Primary outcomes were changes in SNOT-22 and Lund-Kennedy (LK) endoscopic scores. All analysis was non-parametric and was conducted using STATA 14.ResultsTwenty-two patients were enrolled in the study with 20 completing the entire protocol. Mean 6-week change in SNOT-22 scores were −2.8 and 1.0 for saline and CS, respectively (p = 0.373). Similarly, mean 6-week change in LK scores were −1.4 and −1.1 for saline and CS, respectively (p = 0.794). Significant period effects were observed with the SNOT-22 score between the randomized groups. No participants experienced negative health effects directly attributable to the administration of intranasal CS.ConclusionCommercially available CS nasal spray did not demonstrate any meaningful subjective or objective improvements in patients with recalcitrant CRSsP.Trial registration NCT02403479. Registered on March 1, 2015.

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Section: Discussionmentioning

confidence: 99%

The effectiveness of topical colloidal silver in recalcitrant chronic rhinosinusitis: A randomized crossover control trial

Scott

Krishnan

Rotenberg

et al. 2017

Journal of Otolaryngology - Head & Neck Surgery

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“…As nasal drops of nanosilver colloids are commonly used to treat rhinitis clinically (Burgert, 2014;Raimondo et al, 2014), this introduces another unconventional way for AgNP exposure to human beings. On one hand, the olfactory receptor cells are in direct contact with both the environment and the central nervous system and the olfactory pathway offers a potential approach for targeting the brain, thus circumventing the blood-brain barrier.…”

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confidence: 99%

Brain‐targeted distribution and high retention of silver by chronic intranasal instillation of silver nanoparticles and ions in Sprague–Dawley rats

Wen

Yang

et al. 2015

J of Applied Toxicology

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The wide applications of silver nanoparticles (AgNPs) have been concerned regarding their unintentional toxicities. Different exposure modes may cause distinct accumulation, retention and elimination profiles, which are closely related with their toxicities. Unlike silver accumulation profiles through other regular administration modes, the biodistribution, accumulation and elimination of AgNPs by intranasal instillation are not fully understood. This study conducted intranasal instillation of polyvinylpyrrolidone-coated AgNPs in neonatal Sprague-Dawley rats at doses of 1 and 0.1 mg kg À1 day À1 for 4 and 12 weeks, respectively. The 4-week recovery was also designed after the 12-week exposure. Silver concentrations in the main tissues or organs were periodically monitored. Parallel exposures using silver ion were performed for the comparative studies. No physiological alterations were observed in AgNP exposures. In comparison, 1 mg kg À1 day À1 silver ions decreased body weight gain and caused mortality of 18.2%, showing ionic silver had a relatively higher toxicity than AgNPs. A relatively higher silver accumulation was observed in silver ion groups than AgNP groups. The silver ion release could not fully explain silver accumulation in AgNP exposures, showing silver distribution caused by particulate silver occurred in vivo. The highest silver concentration was in the liver at week 4, while it shifted to the brain after a 12-week exposure. Dose-related silver accumulation occurred for both AgNP and silver ion groups. The time course revealed a uniquely high concentration and retention of brain silver, implying chronic intranasal instillation caused brain-targeted silver accumulation. These findings provided substantial evidence on the potential neuronal threat from the intranasal administration of AgNPs or silver colloid-based products.

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“…It was concluded that skin argyria is a consequence of the long-term intake of silver preparations into the body both from the inside (through the stomach) and from the outside (ingrained silver dust). Subsequently, cases of skin argyria were noted with the use of silver drugs (silver nitrate, collargol, and protargol) [30][31][32][33]. Thus, professional and medicinal skin argyria were distinguished [30].…”

Section: Introductionmentioning

confidence: 99%

Hypothetical Mechanism of Skin Argyria

et al. 2022

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Introduction. Argyria is an acquired skin condition that appears after the exposure or consumption of silver, leading to blue or grey coloration of the skin and mucosa. The aim of the present work was to draw researchers’ attention to two aspects of the argyria that until now have not received enough consideration. They are: (1) the process of delivering silver compound from the gastrointestinal tract to the skin and (2) the possibility for silver chloride to participate in this process along with the silver proteinates. Methodology. Illustrative experiments included the observation of color change (visual and using UV-Vis spectrometry) under different light exposure conditions of silver chloride sol in a sweat-simulating solution, in vials and under pig skin (in direct contact). Results and Discussion. A hypothetical mechanism based on a perspiration system for delivering the silver compounds from the gastrointestinal tract to the skin for argyria was proposed. It was also proposed not to completely exclude the partial participation of silver chloride along with the silver proteinates in this process.

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Iatrogenic Rhinopharyngeal Isolated Argyria Induced by Silver-Containing Nasal Drug

Cited by 5 publications

References 1 publication

The effectiveness of topical colloidal silver in recalcitrant chronic rhinosinusitis: A randomized crossover control trial

The effectiveness of topical colloidal silver in recalcitrant chronic rhinosinusitis: A randomized crossover control trial

Brain‐targeted distribution and high retention of silver by chronic intranasal instillation of silver nanoparticles and ions in Sprague–Dawley rats

Hypothetical Mechanism of Skin Argyria

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