Kwon, Hyok Bu; Lee, Joon Ho; Lee, Seung Ho; Lee, Ai Young; Choi, Jong Sun; Ahn, Yeon Soon
Argyria is a rare cutaneous discoloration caused by the intake of silver or various compounds containing silver. We report a case of argyria in a 73-year-old male following ingestion of colloidal silver as an alternative medicine over 5 years. He had a diffuse, slate gray discoloration of his face and hands. A biopsy specimen from the face revealed brown-black extracellular granules in the upper dermis and between collagen bundles. We also found silver particles in the mucous of the colon. Th...
Full Text Available A 70-year-old male rural worker was referred to our clinic with widespread grey pigmentation of the skin and nails. The condition had been asymptomatic for its entire duration (5 years. He reported past intranasal application of 10% Silver Vitellinate. A skin biopsy was performed and histology corroborated the clinical diagnosis of Argyria. This case represents a currently rare dermatological curiosity. Although silver colloids and salts have been withdrawn and/or banned by some drug surveillance agencies, they continue to be freely sold and unregulated as food supplements and as ingredients in alternative medicines, thereby risking the emergence of new cases of silver poisoning.Um homem de 70 anos, trabalhador rural, foi referenciado à nossa consulta por dermatose assintomática, com 5 anos de evolução, caracterizada pela pigmentação acinzentada generalizada da pele, mais evidente em áreas fotoexpostas, e das lâminas ungueais. Relatava no passado o uso prolongado de Vitelinato de Prata a 10%, por via nasal. Foi efetuado exame histológico de biopsia cutânea que corroborou o diagnóstico clínico de Argiria. O caso representa uma curiosidade dermatológica, atualmente rara. Apesar de abandonados e/ou proibidos por algumas instituições de farmacovigilância, a prata coloidal e sais de prata continuam a ser comercializados como suplementos alimentares, como parte de medicinas alternativas e sem regulação, podendo fazer ressurgir os casos associados à toxicidade pela prata.
Kwon, Hyok Bu; Lee, Joon Ho; Lee, Seung Ho; Lee, Ai Young; Choi, Jong Sun; Ahn, Yeon Soon
Argyria is a rare cutaneous discoloration caused by the intake of silver or various compounds containing silver. We report a case of argyria in a 73-year-old male following ingestion of colloidal silver as an alternative medicine over 5 years. He had a diffuse, slate gray discoloration of his face and hands. A biopsy specimen from the face revealed brown-black extracellular granules in the upper dermis and between collagen bundles. We also found silver particles in the mucous of the colon. The ingestion of colloidal silver appears to be increasing among patients using alternative health practices. We report this case to bring people's attention to the problems associated with the ingestion of colloidal silver.
Maria Leonor Enei
Full Text Available Argyria is a rare disease caused by prolonged skin contact with silver. Localized cases have been described regarding the use of topical medications, and trauma with objects containing this metal such as acupuncture needles and jewelry. Clinically, a macule or a patch, round or oval, appears in the infected area, with a characteristic bluey-gray color. To our knowledge this is the first time that this clinical condition has been described through the use of dermoscopy.A argíria é uma doença rara, causada pelo contato prolongado da pele com prata. Foram descritos casos localizados relacionados ao uso de medicamentos tópicos e traumas com objetos que contem esse metal, como agulhas de acupuntura e jóias, por exemplo. Clinicamente, aparecem máculas ou manchas redondas ou ovais na área afetada, com uma característica cor azul-acinzentada. Até onde sabemos esta é a primeira vez que este quadro clínico foi descrito através da dermatoscopia.
Kim, Yangho; Suh, Ho Seok; Cha, Hee Jeong; Kim, Suk Hwan; Jeong, Kyoung Sook; Kim, Dong Hoon
A 58-year-old woman was referred to our hospital due to progressive skin darkening, which began 5 months previously. The patient had strikingly diffuse blue-gray discoloration of the skin, most prominent in sun-exposed areas, especially her face and hands. The oral mucosa, tongue, gums, eye conjunctiva, ears, nail beds, and trunk were also involved. Bluish-gray discoloration of all nails was aggravated by cold weather. She had ingested 1 L of colloidal silver solution daily for approximately 16 months as a traditional remedy. Her serum silver concentration was 381 ng/ml which was a very high (reference level: silver and sulfur in the dense black deposits. The ingestion of colloidal silver appears to be an increasing practice among patients using alternative health practices. All silver-containing products including colloidal silver should be labeled with a clear warning to prevent argyria, especially in alternative health practices.
Gaslin, Michael T; Rubin, Cory; Pribitkin, Edmund A
Long-term use of silver-containing products is associated with a permanent bluish-gray discoloration of the skin known as argyria, but they remain widely available despite several measures by the FDA to regulate them. Several recent case reports have described the occurrence of argyria as a result of using these "natural" products. We used the five most common Internet search engines to find Web sites providing information on silver-containing nasal sprays. Of 49 Web sites analyzed, only 2 (4%) mentioned argyria as a possible complication, although 30 (61%) did caution against long-term use. Eight sites (16%) made specific claims about the health benefits of the product. All 49 sites (100%) provided direct or indirect links to buy silver-containing nasal sprays. We conclude that information about silver-containing nasal sprays on the Internet is misleading and inaccurate. Therefore, otolaryngologists should be aware of the misinformation their patients may be receiving about these products.
Alan B. G. Lansdown
Full Text Available Silver is used widely in wound dressings and medical devices as a broad-spectrum antibiotic. Metallic silver and most inorganic silver compounds ionise in moisture, body fluids, and secretions to release biologically active Ag+. The ion is absorbed into the systemic circulation from the diet and drinking water, by inhalation and through intraparenteral administration. Percutaneous absorption of Ag+ through intact or damaged skin is low. Ag+ binds strongly to metallothionein, albumins, and macroglobulins and is metabolised to all tissues other than the brain and the central nervous system. Silver sulphide or silver selenide precipitates, bound lysosomally in soft tissues, are inert and not associated with an irreversible toxic change. Argyria and argyrosis are the principle effects associated with heavy deposition of insoluble silver precipitates in the dermis and cornea/conjunctiva. Whilst these changes may be profoundly disfiguring and persistent, they are not associated with pathological damage in any tissue. The present paper discusses the mechanisms of absorption and metabolism of silver in the human body, presumed mechanisms of argyria and argyrosis, and the elimination of silver-protein complexes in the bile and urine. Minimum blood silver levels consistent with early signs of argyria or argyrosis are not known. Silver allergy does occur but the extent of the problem is not known. Reference values for silver exposure are discussed.
Hadrup, Niels; Lam, Henrik R
Orally administered silver has been described to be absorbed in a range of 0.4-18% in mammals with a human value of 18%. Based on findings in animals, silver seems to be distributed to all of the organs investigated, with the highest levels being observed in the intestine and stomach. In the skin, silver induces a blue-grey discoloration termed argyria. Excretion occurs via the bile and urine. The following dose-dependent animal toxicity findings have been reported: death, weight loss, hypoactivity, altered neurotransmitter levels, altered liver enzymes, altered blood values, enlarged hearts and immunological effects. Substantial evidence exists suggesting that the effects induced by particulate silver are mediated via silver ions that are released from the particle surface. With the current data regarding toxicity and average human dietary exposure, a Margin of Safety calculation indicates at least a factor of five before a level of concern to the general population is reached.
Sterling, Jose P
Medical and non-medical uses of silver are increasing. While the health benefits of silver therapy are widely claimed, few studies address the possible side effects of resistance, allergy, or skin discoloration. In this manuscript, a review of silver absorption, mechanism of action, allergy, microbial resistance and skin changes is presented. The ideal silver-delivery system is unknown. Most studies of side effects are animal or laboratory studies, which may not correlate with human experience. There is little correlation between serum silver levels, end-organ deposition and cytotoxic effects. The multiple mechanisms of antimicrobial action make true resistance unlikely. In microbes, genotypic resistance does not necessarily confer phenotypic resistance. Most cases of argyria occur from occupational exposure or from ingestion of colloidal silver rather than from topical application. Although toxicity, resistance and chronic skin changes are a theoretic concern, the lack of reported side effects despite widespread silver use is reassuring.
Castillo, J L; Rivera, S; Aparicio, T; Lazo, R; Aw, T-C; Mancl, L L; Milgrom, P
Tooth sensitivity is a common clinical problem. This multi-center randomized clinical trial assessed the effectiveness and safety of topical diammine silver fluoride. From two sites (Lima and Cusco, Peru), 126 adults with at least one tooth sensitive to compressed air were randomly assigned to either the experimental treatment or sterile water, and pain was assessed by means of a 100-mm visual analogue scale at 24 hours and 7 days. The diammine silver fluoride reduced pain at 7 days at both sites. At the Lima site, the average change in pain scores between baseline and day 7 for the silver fluoride group was -35.8 (SD = 27.7) mm vs. 0.4 (SD = 16.2) mm for the control group (P < 0.001). In Cusco, the average change in pain scores for the silver fluoride group was -23.4 (SD = 21.0) mm and -5.5 (18.1) mm for the control group (P = 0.002). No tissue ulceration, white changes, or argyria was observed. A small number of participants in the silver fluoride group experienced a mild but transient increase in erythema in the gingiva near the tooth. No changes were observed in the Gingival Index. We concluded that diammine silver fluoride is a clinically effective and safe tooth desensitizer.
Full Text Available Kesenia Stafeeva, Michael Erlanger, Raul Velez-Montoya, Jeffrey L OlsonDepartment of Ophthalmology, University of Colorado School of Medicine, Rocky Mountain Lions Eye Institute, Colorado, CO, USAAbstract: This case report describes the clinical, autofluorescence, and optical coherent tomography findings in a patient with panocular argyrosis secondary to chronic intake of diluted silver nitrate salts in his water supply. An 86-year-old Caucasian male with a distinctive gray-bluish hue of the skin presented to our clinic, having developed a slow decrease in visual acuity in both eyes and nyctalopia for the past 2 years. Based on the patient's history of chronic intake of silver nitrate salts and a positive skin biopsy (performed by the dermatology department, data not shown, a diagnosis of panocular argyrosis was made. Fluorescein angiography showed choroidal blockage with a completely dark choroid. Fundus autofluorescence was within normal limits. Optical coherent tomography showed multiple excrescences of retinal pigment epithelium in both eyes. Although the drusen-like changes on fundus examination and retinal pigment epithelium changes may account for the diminished vision, the presence of concomitant nyctalopia suggests underlying damage of the photoreceptors.Keywords: silver nitrate, argyria, ocular argyrosis, fundus autofluorescence, optical coherent tomography
Full Text Available Silver nitrate is commonly recognized for the toxic effects followed by the direct contact with the skin and mucosa known as argyria, but there is surprisingly little information about the adverse effects of silver nitrate after ingestion. Since only a few cases were reported in the literature, the aim of this case is to enrich the little experience existent about the possible effects of silver nitrate ingestion. We describe the case of a 15-year-old female who intentionally ingested 15cc of silver nitrate solution in a suicidal attempt. The clinical picture included an excruciating burning sensation in her throat and nostrils followed by vomiting and poor oral intake. The presence of a whitish membrane on the oral and buccal mucosa without bleeding or erosions was the only remarkable finding at physical examination. Unlike the rest of the cases described in the literature the clinical and endoscopic follow up of the patient was benign and without sequela or signs of oesophageal damage. Even though very uncommon, it is very important for physicians to keep in mind the possible toxic effects and appropriate management of silver nitrate ingestion. The outcome is not always devastating as reported, and a good early approach and follow up is important in the anticipation of sequela.
Miyayama, Takamitsu; Arai, Yuta; Hirano, Seishiro
Silver (Ag) possesses a well-known antibacterial activity and has been used for medical treatment and cosmetics such as wound dressing and deodorant powders. Occupational Safety and Health Administration (OSHA) and Mine Safety and Health Administration (MSHA) proposed that the permissible exposure limit (PEL) for both metallic and most soluble Ag compounds should be 0.01 mg/m3. Argyria and argyrosis are known to be caused by deposition of insoluble Ag in the dermis and cornea/conjunctiva. However, the metabolic behavior and biological roles of Ag have not been well characterized in mammals. Ag can be absorbed into the systemic circulation from drinking water, and also through parenteral routes such as inhalation and dermal exposure. Experimental studies have demonstrated that Ag+ induces and binds to metallothionein I and II (MTs), which are cysteine-rich proteins, in cells. MTs are major cytoplasmic metal binding proteins and thereby reduce cellular damage caused by toxic heavy metals including Ag. Profiles of Ag distribution in MTs and other Ag-binding proteins can be determined using high performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICP-MS). This technique directly provides information on the intracellular behavior of Ag, which is important for elucidating the mechanism underlying Ag toxicity. Silver nanoparticles (AgNPs) are also commercially used mainly as antimicrobial agents. Despite the widespread use of AgNPs, relatively few studies have been undertaken to evaluate the health effects of AgNP exposure. In the present paper, we discuss the absorption, toxicodynamics, and metabolism of both Ag and AgNPs in mammals and their health effects.
Full Text Available Objective: To study the analgesic activity of ash of silver used in Indian system of medicine and to explore its safety. Materials and Methods: Albino mice of either sex (20-30 gm were used to investigate the role of ash of silver against noxious stimuli: thermal (Eddy′s hot plate and analgesiometer, mechanical (tail clip, and chemical (0.6% acetic acid induced writhing. An effort was made to find nature and site of action of ash of silver following naloxone pre-treatment. Maximum tolerated dose (MTD and lethal dosage 50 (LD50 were also studied along with toxicological aspects of ash of silver. Results: Test drug (ash of silver at a dose of 50 mg/kg p.o exhibited analgesic activity against thermal, mechanical, and chemical stimuli. Analgesic effects were compared with the standard drug, morphine, in thermal and mechanical noxious stimuli and to aspirin in chemical stimulus. Analgesic activity of the test drug was reduced following naloxone pre-treatment. MTD was found out to be greater than 1.5 g/kg p.o. LD50 was 2 g/kg p.o. Fraction of mice showed symptoms of argyria as explained by autopsy reports. Conclusion: Test drug exhibited moderate analgesic activity at 50 mg/kg p.o against all type of noxious stimuli, also suggesting a role of opioidergic system. The ash of silver was been found to be safe upto a dose of 1.5 g/kg p.o. in mice without any untoward toxicity. Further studies are required to explore the effect of ash of silver on pain mediators and excitatory neurotransmitters like glutamate, aspartate, or N-methyl-D-aspartic acid (NMDA.
Gazda, Daniel B.; Nolan, Daniel J.; Rutz, Jeffrey A.; Schultz, John R.; Siperko, Lorraine M.; Porter, Marc D.; Lipert, Robert J.; Flint, Stephanie M.; McCoy, J. Torin
presence of high levels of iodine in water can cause taste and odor issues that result in decreased water consumption by the crew. There are also concerns about potential impacts on thyroid function following exposure to high levels of iodine. With silver, there is a risk of developing argyria, an irreversible blue-gray discoloration of the skin, associated with long term consumption of water containing high concentrations of silver. The need to ensure that safe, effective levels of biocide are maintained in the potable water systems on the ISS provides a perfect platform for evaluating the suitability of CSPE technology for in-flight water quality monitoring. This paper provides an overview of CSPE technology and details on the silver and iodine methods used in the CWQMK. It also reports results obtained during in-flight analyses performed with the CWQMK and briefly discusses other potential applications for CSPE technology in both the spacecraft and terrestrial environments.