Rapid onset of argyria induced by a silver-containing dietary supplement

Abstract

We describe a 53-year-old man in good general health who presented with an 8-month history of progressive gray hyperpigmentation of the face. He denied using any prescription medications; however, he admitted to taking a herbal supplement. Clinically, the differential diagnosis included hemochromatosis, Wilson's disease and hyperpigmentation secondary to supplement use. Punch biopsies from the left forehead and preauricular region showed heavily sun-damaged skin with a minimal inflammatory infiltrate. Closer inspection, however, revealed minute scattered black/brown particles distributed in the basement membrane zone of eccrine and sebaceous glands. Similar particles were also present in hair follicles, blood vessels and arrector pili muscles. The particles did not stain with Gomori methenamine silver, Fontana-Masson or iron stains. Electron microscopy with energy-dispersive x-ray analysis showed numerous particles, less than 1 µm in greatest dimension, which showed peaks for silver and sulfur. This analytical result confirmed the impression of argyria. Further history revealed that the patient had indeed been taking a silver supplement for several months under the premise that it would boost his immune system. This case is unique in that the patient's hyperpigmentation developed in a short period of time as compared with other reports in the medical literature.

Impact of food components during in vitro digestion of silver nanoparticles on cellular uptake and cytotoxicity in intestinal cells

“…Munger and colleagues reported the presence of silver in serum samples after ingestion of particles with diameters between 5 and 10 nm. This is in line with reported cases of argyria after ingestion of dietary supplements containing silver (Bowden et al, 2011). Taken together, these findings indicate that Caco-2 cultures are well-suited for studying the uptake of silver nanoparticles into the intestinal mucosa, while caution should be exercised when predicting oral bioavailability of the particles with this model.…”

Clinical characteristics of adult-onset actinic prurigo in Asians: A case series

“…The pigmentation is subtle and goes unrecognized for months and years. [6,32,33,46] It is more pronounced on sun exposed areas including face, neck, [ Figure 1] arms and dorsum of the hands. [2] It is often viewed by the patient as persistent tan.…”

Acitretin in dermatology

“…[45] Acitretin has been used as an adjunct to imiquimod therapy and excision in giant condyloma acuminata. [46] In another case report acitretin improved clinical lesions of blastomycosis like pyoderma resistant to all conventional therapies within 3 months of starting treatment and there was nonrecurrence until 9 months of stopping therapy. [47] Acitretin has been reported to cause improvement with almost complete clearing in cutaneous lesions of a 64-year-old case of elephantiaisis nostras verrucosa (nonfilarial in origin) with coexisting erythrodermic psoriasis.…”