Derm Dx: Striking pigmentation on a former chemical plant worker - Clinical Advisor

Derm Dx: Striking pigmentation on a former chemical plant worker

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A 43-year-old man who has impaired mentation and currently resides in an extended-care facility is being followed for discoid lupus erythematosus affecting his right cheek. On examination, in addition to facial plaque, striking generalized pigmentation is noted, most prominently on his face and arms. According to caretakers, the pigmentation has been present for decades and is related to past occupational exposure at a chemical plant.

Argyria results from prolonged contact or ingestion of silver salts and may affect workers involved in the silver industry. The condition is characterized by gray to gray-black staining of the skin and mucous membranes.1 Colloidal silver dietary supplements, marketed for...

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Argyria results from prolonged contact or ingestion of silver salts and may affect workers involved in the silver industry. The condition is characterized by gray to gray-black staining of the skin and mucous membranes.1 Colloidal silver dietary supplements, marketed for a variety of ailments, have also been linked to the development of this disorder. Argyria typically occurs in sun-exposed areas, but localized argyria has appeared at the site of acupuncture needles and after wearing silver earrings.2,3

 

Treatment options are limited. Sunscreens may be helpful in preventing further pigmentary changes, and cosmetics can aid in masking discoloration. Topical bleaching agents are not effective. Argyria caused by colloidal silver ingestion has been treated successfully using the Q-switched 1064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser.4,5 Because of the universal recognition of silver toxicity, the incidence of systemic argyria has diminished markedly.

Michael Stas, DPM, is a podiatry-dermatology fellow at St. Luke’s University Hospital in Bethlehem, Pennsylvania, and at the DermDox Dermatology Center in Hazleton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Krejci-Manwaring J, West DA, Aires DJ. What is your diagnosis? Argyria. Cutis. 2013;91:224,233-234.
  2. Legat FJ, Goessler W, Schlagenhaufen C, Soyer HP. Argyria after short-contact acupuncture. Lancet. 1998;352:241.
  3. Rackoff EM, Benbenisty KM, Maize JC, Maize JC Jr. Localized cutaneous argyria from an acupuncture needle clinically concerning for metastatic melanoma. Cutis. 2007;80:423-426.
  4. Rhee DY, Chang SE, Lee MW, Choi JH, Moon KC, Koh JK. Treatment of argyria after colloidal silver ingestion using Q-switched 1,064-nm Nd:YAG laser. Dermatol Surg. 2008;34:1427-1430.
  5. Han TY, Chang HS, Lee HK, Son SJ. Successful treatment of argyria using a low-fluence Q-switched 1064-nm Nd:YAG laser. Int J Dermatol. 2011;50:751-753.
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