Mucocutaneous Hyperpigmentation in a Patient With a History of Both Minocycline and Silver Ingestion.

Minocycline is a derivative of tetracycline. It has been widely used in dermatology for the treatment of acne and rosacea. One of its adverse effects is pigmentation of various body tissues. Clinically, 3 main distinct types of hyperpigmentation by minocycline have been distinguished: type I, with blue-gray to black pigment on the face in areas of scarring or inflammation; type II, with blue-gray pigment on normal skin of the legs, forearms and on the shins; and type III, with a diffuse muddy-brown discoloration in areas of sun exposure. In the current report, we present the case of a 50-year old man with a history of severe acne treated with minocycline in the past, who currently complained about discoloration of his face. He had also taken colloidal silver supplements for "good health" about 16 years ago. Physical examination revealed gray-blue discoloration on the face, sclera, hard palate and back. Histologic examination showed intracellular pigment deposits in macrophages of the superficial dermis in a perivascular and an interstitial distribution. The pigment stained with Fontana-Masson and von Kossa, whereas it was Perls' iron negative. This case does not fit well into any of the previously described patterns of minocycline-related hyperpigmentation.

Resident Rounds: Part III - Case Report: Argyria ­ A Case of Blue-Gray Skin.

Argyria is an uncommon blue-gray pigmentation of the skin (increased in sun-exposed areas), nail unit, and mucous membranes caused by prolonged silver exposure. Commonly occurs in the setting of occupational exposure, silver-containing medications, or systemic absorption from use of silver sulfadiazine on extensive burns/wounds. Recently, there appears to be an increase in the practice of colloidal silver ingestion given the popularity and easy availability of alternative medicines and dietary supplements containing various silver-containing compounds. We report a case of argyria in a 72-year-old male following ingestion of colloidal silver as a supplement for over 10 years. He had a diffuse, blue-gray discoloration of his face and nails. A skin biopsy was performed and histology supported the clinical diagnosis of argyria. Our objective is to increase the awareness for this rare dermatologic entity by highlighting the clinical and histological features through a case report. Dermatologists should warn patients in regards to the use of colloidal silver for alternative health practices.

Dystrophic calcification and accentuated localized Argyria after fractionated carbon dioxide laser therapy of hypertrophic scars.

IMPORTANCE: Fractionated, ultrapulsed carbon dioxide (CO2) laser therapy is a powerful tool for the treatment of scars. Common adverse effects of this therapeutic modality have been previously documented. We describe 2 unreported adverse effects of ultrapulsed CO2 laser treatment of mature scars in a patient previously treated with silver-impregnated dressings. OBSERVATIONS: A teenage survivor of toxic epidermal necrolysis presented with faint but diffuse dyschromia clinically and histologically consistent with localized argyria secondary to silver-impregnated dressings used years earlier. The patient was subsequently treated with fractionated CO2 for her scarring, but her hyperpigmentation worsened with each treatment. A subsequent biopsy specimen revealed a zone of dystrophic calcification with adjacent pseudo-ochronotic fibers that were not appreciated on biopsy specimens taken before CO2 laser treatment, suggesting unique complications not previously reported. CONCLUSIONS AND RELEVANCE: We present 2 unique complications secondary to ultrapulsed, fractionated CO2 laser treatment in a patient previously treated with silver-impregnated dressings: (1) the appearance of pseudo-ochronotic fibers in areas of worsening pigmentation and (2) evidence of dystrophic calcification limited to columns of fractionated laser ablation. Therefore, a history of argyria or treatment with silver-impregnated dressings should be considered before treatment with fractionated CO2 lasers.

A case of argyria: multiple forms of silver ingestion in a patient with comorbid schizoaffective disorder.

Argyria is a rare cutaneous manifestation of silver deposits in the skin, characterized by a grayish blue discoloration, particularly in sun-exposed areas. We report the case of a patient with a history of schizoaffective disorder and type 2 diabetes mellitus who presented with argyria of the face and neck. The patient had a history of ingesting colloidal silver proteins (CSPs) for approximately 10 years as a self-prescribed remedy for his medical conditions. Colloidal silver protein has gained popularity among patients who seek alternative medical therapies. Argyria is the most predominant manifestation of silver toxicity. It is unclear if our patient began taking CSP because of his schizoaffective disorder or if silver toxicity may have induced somatic delusions; however, it is important for physicians to have a thorough understanding of alternative therapies on the market. We present a detailed background on silver ingestion and its systemic effects.

Rapid onset of argyria induced by a silver-containing dietary supplement.

We describe a 53-year-old man in good general health who presented with an 8-month history of progressive gray hyperpigmentation of the face. He denied using any prescription medications; however, he admitted to taking a herbal supplement. Clinically, the differential diagnosis included hemochromatosis, Wilson's disease and hyperpigmentation secondary to supplement use. Punch biopsies from the left forehead and preauricular region showed heavily sun-damaged skin with a minimal inflammatory infiltrate. Closer inspection, however, revealed minute scattered black/brown particles distributed in the basement membrane zone of eccrine and sebaceous glands. Similar particles were also present in hair follicles, blood vessels and arrector pili muscles. The particles did not stain with Gomori methenamine silver, Fontana-Masson or iron stains. Electron microscopy with energy-dispersive x-ray analysis showed numerous particles, less than 1 µm in greatest dimension, which showed peaks for silver and sulfur. This analytical result confirmed the impression of argyria. Further history revealed that the patient had indeed been taking a silver supplement for several months under the premise that it would boost his immune system. This case is unique in that the patient's hyperpigmentation developed in a short period of time as compared with other reports in the medical literature.

Localized argyria secondary to acupuncture mimicking blue nevus.

The typical clinical manifestation of localized cutaneous argyria is a blue-grayish asymptomatic macule, which may be caused by occupational exposure, topical treatment, dental amalgams and alternative medicine therapies. The lesions often are clinically indistinguishable from blue nevi and metastatic melanoma. The authors present a case of localized cutaneous argyria secondary to an acupuncture needle, emphasizing the importance of keeping this entity in mind in the differential diagnosis of blue-grayish pigmented lesion in a body area that could have been treated with acupuncture.

A case of generalized argyria after ingestion of colloidal silver solution.

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: <15 ng/ml). Light microscopic examination of a punch biopsy specimen from her nose revealed fine, minute, round, and brown-black granules deposited in the basement membrane of hair follicular epithelium. Scanning electron microscopic examination showed electron-dense granules deposited in the intercellular space of sweat glands. Energy disperse X-ray spectrometry analysis demonstrated peaks for 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.

Case report: skin discoloration following administration of colloidal silver in cystic fibrosis.

PURPOSE OF REVIEW: Complementary and alternative medicine therapies are frequently combined with conventional medical treatment and can significantly affect patient care. In the following case, an adjunctive modality posed a significant health risk to the patient. RECENT FINDINGS: An 11-year-old boy with cystic fibrosis reported a bluish skin color after he began ingesting a colloidal silver solution to facilitate mucus clearance. Serum silver level was elevated to more than twice the upper limit of normal. This finding is highly suggestive of argyria, a typically permanent discoloration of the skin due to dermal silver deposits. In this child, however, the discoloration was transient and the silver level normalized when the therapy was discontinued. SUMMARY: Although a diagnosis of argyria was not formally made, this case reviews the known dangers associated with silver ingestion. Complementary and alternative medicine therapies are common and can both augment and interfere with the traditional standard of care. Informed providers who inquire about the use of these therapies can then discuss the risks and benefits of each utilized modality.