CASE REPORT
A 72-year-old white male with a past medical history
of myocardial infarction, chronic kidney disease,
and diabetes mellitus presented to our institution
for evaluation of blue-gray discoloration of the face. This
was first noted by the patient about 10 years prior and had
slowly worsened over the years. The patient intermittently
used a supplemental product containing colloidal silver to
gargle and apply to wounds in the prevention of upper respiratory
infections and wound healing. The patient reported
that serum and urine silver levels had tested negative, and
the well water supplying his house did not have elevated silver
levels. The patient denied previous use of amiodarone or
minocycline.
On physical examination, the patient had diffuse blue-gray discoloration
in the sun-exposed areas of his scalp, face, and neck
(Figure 1a). The lunulae and hard palate were involved as well
(Figure 1b). The patient’s wife, who also uses colloidal silver,
had similar blue-gray discoloration, but to a lesser extent.
Histopathologic examination of a punch biopsy specimen
from the left forehead revealed multiple, small brown-black
silver granules within the dermis, primarily concentrated
around eccrine glands (Figure 2).
DISCUSSION
Argyria is a rare skin condition resulting from chronic
exposure to silver, and is characterized by diffuse
blue-gray discoloration predominantly in sun-exposed areas.
Occurrence is common in settings of occupational exposure,
silver-containing medications, or systemic absorption from
use of silver sulfadiazine on extensive burns/wounds.1,2,3
Histologically, granules of silver are found in basement
membrane and in the dermis, especially around eccrine
glands.4
Although most patients with argyria have no systemic symptoms
or consequences, it can cause psychosocial stress.
A number of therapies have been used to treat the discoloration,
such as depigmenting creams, hydroquinone,
dermabrasion, and chelation. However, most of them have
been ineffective.5 In one patient, the use of a Q-switched 1064
Nd:YAG laser showed improvement.6 Sun protection may
help prevent further pigmentary darkening.
Though we advised our patient to discontinue colloidal
silver use, we believe more cases of argyria related to
