Argyria - Causes, Complications, and Prevention

Introduction

Argyria is a Greek word meaning silver. Argyria is a rare dermatological disorder caused by exposure or the ingestion of silver particles. Silver is used in day-to-day activity in jewelry, present in water content and medications. Discoloration of the skin depends upon the amount of silver exposure, a small amount of silver for a prolonged or a large amount of silver for a short time. The hypopigmentation leads to a state of gray, grayish-blue, or metallic silver color, and the change is permanent.

What Are the Causes of Argyria?

The amount of silver deposition causes argyria; it can turn the skin, mucosal membrane, eyes, and even internal organs into grayish-blue color, especially in the areas which mostly have sunlight exposure.

The types of causes can be related to -

1. Occupational Exposure - The worker working in silver mining, silver refining, and silver metal alloy has a lot of exposure to silver particles; in the factories, silver particles are present in the air that the worker inhales, and from the lungs, the blood carries the particles and deposits them into the skin, causing argyria.

2. Medication and Drugs - The administration of drugs having silver salts like-

• Silver nitrate is used for the treatment of varicose veins and bleeding gums.

• Silver salts are used for irrigating urethral, gastric lavage, and wound dressing.

• Silver Sulfadiazine ointments are used in infections and burns.

3. Diseases - Colloidal silver dietary supplements are indicated for the treatment of cancer, HIV (human immunodeficiency virus), AIDS (acquired immunodeficiency syndrome), arthritis, and diabetes.

4. Silver Restorations - Surgical and dental procedures using silver sutures and silver restorations used for dental cavities.

5. Sensitive Skin - Some people with highly sensitive skin may have a high chance of developing argyria by wearing silver ornaments and ear or nose piercings with silver-coated needles.

6. Smoking - Silver Acetate is advised for quitting smoking.

What Are the Clinical Features of Argyria?

Argyria can be generalized or localized pigmentation, and it can be related to the areas that are more exposed to sunlight.

• In generalized argyria, the hypopigmentation starts with a small stain and gradually involves the large areas.

• The pigmentation depends on the silver salts deposited on the skin, the degree of exposure to sunlight, and the amount of melanin production that results in skin discoloration.

• More silver exposure with a short period of time and a small amount of silver with prolonged exposure affects the skin and lead to grayish-blue discoloration.

• By ingestion, silver gets collected in the stomach, and the acid in the lining of the stomach walls erodes the silver particles, through which the silver travels in the bloodstream and deposits in the skin, and affects the internal organs.

• Localized argyria depends on the site of the exposure; it can occur in the white of the eyes by prolonged use of eyedrops containing silvers, also known as - Argyrosis.

• Discoloration can be seen in nails and earlobes.

• The localized argyria can be an initiation of generalized argyria.

What Is Silver Toxicity?

Silver toxicity occurs due to the excessive deposition of silver particles in the bloodstream. The inhalation or ingestion of silver particles, depending on the amount of silver and the period of exposure, leads to the accumulation of silver in the different internal organs. The excessive silver particles can be excreted out from the body in the form of feces. Silver toxicity is unusual, as silver particles are present in day-to-day life, whether it is used as an ornament or in dietary supplements.

What Happens to Skin When Silver Particles Get Deposited?

The silver deposition in the skin leads to histopathological changes in the skin structure.

Presence of numerous small blue-black granules in the basement membrane involving elastic and collagen fibers within the dermis. These tiny granules can be seen by taking a section of the skin and staining it with hematoxylin and eosin under a microscope. This condition is not precancerous or cancerous.

What Is the Investigation for the Diagnosis of Argyria?

The argyria can be evaluated by recording the patient's past medical and personal history and physical examination. The hematological biopsy is a confirmation investigation for argyria.

Energy-dispersive x-ray spectroscopy is a non-invasive investigation that can also help diagnose argyria.

What Is the Differential Diagnosis of Argyria?

Discoloration of the skin can be related to some other disorders as well; therefore, argyria can be diagnosed as some other skin diseases such as -

1. Melanoma - Discolouration of the skin caused due to excessive deposition of melanin.

2. Cyanosis - Skin color turning blue due to lack of oxygenated blood supply.

3. Exogenous Ochronosis - Hypopigmentation due to prolonged use of cosmetic products for skin brightening.

4. Chrysiasis - Excessive use of gold salts for medication purposes.

5. Hemochromatosis - Excessive absorption of iron by the body.

6. Methylene Blue Poisoning - Methylene blue is used as a therapeutic agent, but its long-term use can cause toxicity.

What Is the Treatment of Argyria?

Argyria is an irreversible skin discoloration disorder and not so curable; however, there are some medical modalities for treating argyria.

1. Chelation therapy and depigmentation agents are advised but cannot help much.

2. The use of 5 % of Hydroquinone can fade the discoloration of the skin.

3. Laser therapy with Q-switched Neodymium Doped Yttrium Aluminum Garnet (Nd: YUG) is done to remove the hyperpigmentation of the skin. This method is the most effective.

What Are the Complications of Argyria?

Argyria is not a fatal skin disorder; overexposure to the silver particle by ingestion or inhalation can lead to systemic problems involving other organs like the liver and kidneys. This can also lead to necrosis of bone, pulmonary embolism, and hemorrhage. The skin discoloration may lead to psychological disturbances; a person may feel low self-stream and less confidence and may undergo depression and anxiety.

What Are the Preventions for Argyria?

Argyria is not a life-threatening disorder, but it can be prevented.

1. Limiting sun exposure.

2. Apply sunscreen while stepping out.

3. Avoiding dietary supplements containing silver particles.

4. Preventing the prolonged administration of silver-containing medications, eyedrops, and lozenges.

5. The workers in the factories exposed to silver particles can inform the government help center like OSHA (occupational safety and health administration) and MSHA (mine safety and health administration).

Conclusion

Argyria is a rare, non-fatal skin disease caused by exposure to or ingestion of silver, resulting in depigmentation of the skin. It can be localized or generalized, turning the skin color grayish-blue. It is irreversible skin discoloration, but it can be prevented. Silver toxicity can be considered a fatal condition if the amount of silver exposure is higher than 50 mg causing pulmonary edema, hemorrhage, and necrosis of bone marrow, liver, and kidneys. A person suffering from such a condition should seek medical attention and consult a dermatologist.