Argyria is a dermatological disease that occurs due to the increased intake of silver ions into the body and its subsequent deposition in the skin and its appendages. The main symptom of the disease is darkening of the skin and mucous membranes up to a bluish-gray shade, in severe cases, visual disturbances are also observed. Diagnosis is based on anamnesis data (detection of contact with silver), examination of the patient, sometimes histological examination of the skin and ophthalmological examination are also used. There is no treatment for this disease, you can only slightly lighten the skin using the method of medical cosmetology (for example, laser dermabrasion).
ICD 10
H11.1 T56.8
General information
Argyria, is a consequence of prolonged contact or ingestion of silver – both in the form of compounds or ions, and in pure form (silver dust, colloidal silver). This condition has been known since ancient times, mainly people working in silver mines, the production of mirrors and jewelry previously suffered from it. In the XX century, the mass use of medicines based on this metal was added to these causes of argyria – in particular, the well-known lapis pencil contains silver nitrate. This element has pronounced bactericidal properties, but its toxicity to humans is quite low. However, large doses of silver ions can cause severe poisoning, the lethal dosage of silver nitrate is about 10 grams. For the development of argyria, a long (at least several years), but constant contact with this metal is necessary.
Causes
When silver ions enter the human body, they only partially participate in metabolism, but this does not immediately lead to argyria. They spread throughout all tissues, but in some of them conditions are created for the accumulation of metal – mainly the upper layers of the dermis, sweat glands, cornea, mucous membranes. In any adult or elderly person, microscopic inclusions of silver can be found in these tissues, but in this case we are not talking about argyria – there is so little metal in them that it does not affect the color of the skin in any way. But if an increased amount of these ions enters the body, then the amount of such deposits increases, which eventually leads to a noticeable change in skin color. It is in this case that the diagnosis of “argyria” is made.
Currently, the main sources of silver are some medicines, cosmetics, dentures based on alloys of this metal. Cases of argyria development due to the long-term use of “silvered” water by electrophoresis or the use of colloidal silver for the same purposes are described. Just as in ancient times, argyria occurs in workers who come into contact with this metal – in this case, we can talk about the professional nature of the disease. It was found out that for a noticeable change in skin color, at least 10-12 years of regular contact with this element or its compounds is necessary.
Argyria symptoms
In clinical dermatology, there are two main forms of argyria – local and generalized. The development of a particular form of the disease depends on the amount of deposited silver in the body, from this point of view, they can be considered as successive stages of this disorder. With local argyria, the deposition of metal is limited to the skin of the periorbital region and the cornea, but no vision problems are observed. The generalized form is characterized by darkening of the remaining areas of the skin – while the severity of symptoms also depends on the amount of silver received in the body and the duration of its accumulation.
The degree of darkening of the skin with general argyria can vary from light gray to dark silver. As a rule, the most exposed areas of the body are exposed to pigmentation – the face, neck, hands. In severe cases, the human body acquires a uniform dark silver color and shine. With argyria of this degree, noticeable deposits are observed not only on the skin, but also in the deep layers of the cornea, which in some cases slightly weakens vision.
If silver continues to enter the body, it begins to be deposited in the retina and tissues of the optic nerve, leading to hemeralopia and a significant decrease in visual acuity. All the above-described symptoms of argyria develop very slowly over many years, but such pronounced pigmentation often causes complexes and psychological problems in the patient.
Diagnostics
In most cases, the diagnosis of argyria does not pose a special problem for a dermatologist – during examination, gray, sometimes with a silvery tint, skin is revealed. When the patient is questioned, it turns out that such changes have been increasing in him for many years. The source of silver intake into the body is also determined. If the patient cannot tell under what circumstances he came into contact with this metal, then the doctor should find out if he does not use any medications, does not use a lapis pencil, where he works – all these data can help identify the cause of argyria. To confirm argyria , it is carried out:
- Skin biopsy. Histological examination of the skin shows the presence of gray inclusions in the cells of the upper layer of the dermis, as well as the intercellular space. With argyria, an increased amount of such inclusions will be observed around the sweat glands and hair follicles, and, conversely, a reduced amount in the sebaceous glands.
- Ophthalmological examination. It detects silver deposits in the cornea in the form of thin intertwined threads of gray-blue color. With pronounced forms of argyria, grains of precipitated metal can be found in the vitreous body. Visual disturbances caused by this condition are accompanied by edema of the optic disc and the presence of dark spots on the retina.
Differential diagnosis of argyria should be carried out with hemochromatosis, Addison’s disease, porphyria and methemoglobinemia – conditions in which pigmentation of the skin is also observed.
Treatment
There is currently no treatment for argyria, only in the early stages you can try to lighten the skin somewhat by laser dermabrasion. However, given that the bulk of silver inclusions are located below the epidermis, the effectiveness of this technique is questioned by a number of dermatologists. The most important thing in detecting argyria is to eliminate the entry of this metal and its compounds into the body to prevent further progression of the symptoms of the disease. To do this, it is important to correctly determine the source of silver – a medicinal or cosmetic product, drinking silver-plated water, professional factors.
Prognosis and prevention
The prognosis of argyria in relation to human life and health is favorable, but often patients are psychologically burdened by the symptoms of this condition. Prevention of argyria is reduced to the correct and limited use of medicines and cosmetics containing this metal, to the fulfillment of safety requirements when working with it.