Argyria: a review with emphasis on the clinical and forensic aspects

Abstract

Background: Argyria encompasses the different cosmetic alterations that can develop if enough silver particles deposit in a specific tissue, typically in the skin, ranging from localized dark-blue macules, following local exposition, to a generalized slate-gray/bluish tinge in an individual's complexion, following systemic absorption. Objective: This work aims to fully review the state-of-the-art regarding pathophysiology, diagnosis, treatment, and relevant clinical and forensic features of argyria. Results: Argyria has been diagnosed in a wide range of ages, both sexes and varied ethnicities, with no known individual predisposing factors. It can develop locally, virtually in any bodily tissue, provided that silver breaches its epithelial lining and reaches connective tissue underneath, or in a generalized pattern, if enough silver reaches the bloodstream. Light exposition aggravates the dyspigmentation due to reduction of the silver deposits. An increase in melanin production also contributes for the skin dyspigmentation. Once settled, it does not resolve irrespective of exposition discontinuation. Physical examination and silver exposure in the anamnesis can be highly suggestive of the diagnosis, but a histopathological analysis with Energy-Dispersive X-ray Spectroscopy is required to unequivocally determine the dyspigmentation etiology. Safe and effective treatment has only been accomplished with laser techniques, namely Q-Switched 1064 nanometers Neodymium-doped Yttrium Aluminium Garnet and Q-Switched Picosecond 755 nanometers Alexandrite Laser, though only few cases have been reported and with limited follow-up time, with prevention remaining the single best tool to avoid argyria. Conclusion: Argyria has typically an occupational or iatrogenic etiology. Its prevalence is decreasing as caution regarding silver exposure increased; on the other hand, the share of cases precipitated by silver exposure via non-conventional medicinal practices and non-supervised self-administration of alleged remedies is of great significance, highlighting the need to raise awareness of this adverse permanent effect. Argyria should be suspected when a patient presents with typical skin or eye lesions. A seemingly viable treatment modality, with laser technology, is finally within the horizon.

Keywords: Argyria; pathophysiology; signs and symptoms; clinical and forensic diagnosis; treatment.