Other medications to consider as causative agents of argyria mimicking discoloration include minocycline, chlorpromazine/phenothiazines, amiodarone, antimalarial agents, and clofazimine . Diagnosis can also be made through histopathological analysis, but to indisputably make an argyria diagnosis, energy-dispersive X-ray spectroscopy would be necessary. ![]() In our case, the presentation afforded a clinical diagnosis to be made. The nails and other localized areas of pigmentary change offer signs of argyria that can be used for early detection prior to larger, generalized skin involvement. Prevention and early detection are preferred. Even with these advancements, there are no effective, established treatments for argyria of the nails. These laser cases show promising results for argyria of the skin but can be painful. Recently, there has been an effort to treat argyria of the skin through laser therapies such as 1064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, 755 nm alexandrite, and low-fluence Q-switched Nd:YAG. Most of the long-term systemic effects reported are hard to substantiate beyond a possible causal relationship. Transient elevation of liver enzymes can be present, but no permanent changes have been described. Some patients with ocular forms of argyria report changes in night vision and other eye-related symptoms. Normally, there are no systemic complications seen with argyria, despite silver’s ability to settle in different tissue types. Once argyria becomes noticeable, it can cause negative psychosocial effects for the patient. Argyria can generally cause noticeable widespread blue-gray pigmentary involvement of the skin. Argyria of the nails (azure lunula) is an early sign of the condition. It is important that patients are aware of the potential risks of consuming over-the-counter supplements containing silver for medicinal purposes. ![]() Argyria of the skin and nails is a side effect associated with ingesting silver products. Upon follow-up six months later, the condition remained stable, showing no further progression of discoloration.Īlthough silver has been used in medicine in different forms, its efficacy, risk versus benefit, and safety profile have not been well defined in the context of over-the-counter supplementation. The expectation was that the progression of the argyria would cease, and the pigmentary changes in the nails would remain stable. ![]() His treatment regimen consisted of the cessation of silver supplementation and the observation of the nails as there are no established treatments for argyria localized to the nails. To avoid its spread and the progressive discoloration of the nails, the patient was directed to discontinue colloidal silver and liquid silver supplementation. ![]() The patient was counseled on argyria, including the permanent and progressive nature of the pigmentary changes associated with the condition if silver ingestion continued. The diagnosis of argyria localized to the nails (also referred to as azure lunula ) was made. The timing and presentation of the nail changes suggested that the patient had developed early argyria limited to the nails secondary to silver consumption. Prior to the nail changes, the patient had started ingesting colloidal silver 30 ppm mixed with liquid silver as a supplement to alleviate symptoms of Barrett’s esophagus. The patient did not have any remarkable pigmentary changes of the skin. During his examination, a mild slate blue-gray hyperpigmentation of the bilateral fingernails was detected (Figure (Figure1 1 and Figure Figure2). The patient’s previous medical diagnoses included anxiety, arthritis, benign prostatic hyperplasia, a cerebrovascular accident, hypertension, Barrett’s esophagus, and prosthetic arthroplasty of the bilateral hips. A 79-year-old male presented to the clinic for a routine skin examination.
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