Histologically, silver particles have a granular appearance of dark brown to black, scattered extracellularly in the dermis and are concentrated in the basement membrane of sweat glands, perifollicular sheath, nerve, capillary walls, and elastic fibers.īy the technique of scanning electron microscopy, electron-dense granules are observed in the lysosomes of macrophages or extracellularly in old lesions. When a large amount of silver is present, the photoactivation and metal reduction cause bluish gray skin in areas exposed to light discoloration and has also been reported to lead to a generalized stimulation of melanin production.Ĭlinically, the main differential diagnosis is with Addison's disease, hemochromatosis, methemoglobinemia pigmentation due to other chemicals such as gold, mercury, arsenic, bismuth drugs such as minocycline, antimalarials, amiodarone, chlorpromazine, quinacrine or chemotherapy. The reservoir may contain a binding protein, is present in many tissues, without clinical effect. The body accumulates a small amount of natural silver, so the total content in the body increases with age. It can be detected in blood and urine, and cause kidney failure. It can manifest as localized with involvement of the cheek mucosa for amalgam tattoos and in the systemic form affects internal organs and accumulates in the liver, kidneys, and spleen. It can also affect eyelids, lacrimal caruncle, semilunar fold, cornea, lens, vitreous humor, retina, and optic dis. The conjunctival pigmentation is bluish gray or dark brown. From nail, lunula is affected, and the hair take on a metallic look. To be present, it requires a total dose of 6 g orally or 1 g intravenously.Ĭlinically, argyria characteristically presents with a blue or blue-gray uniform pigmentation of the skin (the sunlight intensifies it), mucous membranes, and nails. Generalized argyria results from an increase in serum silver levels, secondary to prolonged ingestion of it in its various forms. Argyria is an extremely rare condition first detailed by Hill and Pillsbury in 1939, that is thought to have disappeared due to the suspension of the use of silver in drugs orally, However, silver is in local antiseptics such as nitrate and sulfadiazine, nasal drops, dental and photographic material, absorbable sutures, powders used in jewellery, acupuncture needles, and supplements, therefore, may also penetrate through the skin or respiratory tract, in addition to digestive.
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