Argyria is a rare condition that occurs when excessive amounts of silver are deposited in the skin and other tissues of the body. The result is a permanent localised or generalised blue-gray discoloration of the skin, mucous membranes, and eyes. "Blue man syndrome" or "silver poisoning" are terms commonly used to refer to this condition.1
Argyria can be caused by exposure to silver in a variety of forms, including ingestion, inhalation, or topical application. Ingestion of silver in the form of colloidal silver, a dietary supplement that is sometimes used for its supposed health benefits, is a common cause of argyria.2 Other potential sources include occupational exposure to silver dust or fumes and the use of silver-containing medical devices.
One of the most well-known cases of argyria was that of Paul Karason, who gained media attention in the mid-2000s due to his blue-gray skin. Karason had been using a homemade silver solution as a treatment for various health conditions, ingesting and applying the solution to his skin for over a decade. While Karason's case is extreme, it illustrates the potential risks associated with using silver compounds as a medical treatment.
Causes of argyria
The sole identified risk factor for developing argyria is exposure to excessive levels of silver. However, it is unclear what level of exposure becomes dangerous. People who take dietary supplements or medications that contain silver, regularly use eye drops or cosmetics containing silver or have an occupation that involves prolonged exposure to silver are at a higher risk of suffering from argyria.
Silver can be found in many products that we consume or use on our bodies. Some of the most common sources of silver exposure include:
- Silver industry: people who work in the silver industry, including silver mining, refining, and jewellery making, are at a higher risk of being exposed to silver
- Photographic processing: the photographic processing industry also exposes workers to silver
- Dietary supplements and medications: certain dietary supplements and medications contain silver. The use of colloidal silver as supplements, taking medication containing silver, and undergoing medical interventions that involve silver products (like silver sutures for surgery or silver fillings in dentistry) can all expose a person to excessive amounts of the metal
- Eye drops and cosmetics: silver-containing eye drops or makeup can cause localised argyria of the eye
- Silver needles and earrings: while wearing silver jewellery or using silver utensils does not tend to cause argyria, silver needles used for acupuncture or silver earrings can cause localised argyria in rare cases
How does silver enter the body?
People tend to store a small amount of silver that has naturally contaminated their bodies. As a person gets older, the stores of silver in the body increase in a cumulative manner. Silver exposure can result in the metal entering the body through the mouth, the skin, or various mucous membranes, like the conjunctiva of the eyes or the mucous in the nose. Once silver reaches your stomach, a chemical reaction is triggered, leading to its breakdown and subsequent entry into your bloodstream.
Typically, the majority of the silver that we consume exits the body through faeces within a week, while a smaller amount is eliminated via urine. However, if you consume excessive amounts of silver, your body may struggle to eliminate it effectively. Any unremoved silver can accumulate in your skin and other tissues, leading to a gradual buildup over time. Eventually, exposure to sunlight activates the silver in your skin, causing it to take on a blue-gray hue.
Signs and symptoms of argyria
The symptoms of argyria can vary depending on the severity and extent of the silver deposition. In some cases, the only symptom may be the characteristic blue-gray discolouration of the skin, which can be localised or widespread. In more severe cases, silver deposition can lead to systemic effects, such as neurological symptoms (like seizures and psychosis ) or kidney damage.
Subtypes of argyria
There are three subtypes of argyria, which are distinguished by the location of silver deposits and what symptoms an affected individual presents with:2
This form of argyria arises from systemic exposure to silver, which is then absorbed by the intermediate layer of the skin called the dermis. This results in a diffuse, metallic appearance of the skin, giving it a gray-blue hue. This colour difference becomes noticeable predominantly in areas that are exposed to the sun. Cases of generalised argyria are typically observed in individuals who use colloidal silver as supplements or as a form of alternative medicine.3
This form of argyria is a result of local silver deposition in the skin. It can occur if silver enters through cuts or the sweat gland pores of the skin. The discolouration can present as clusters of spots that often appear black.
The most frequently encountered type of localised argyria is known as an amalgam tattoo. It is caused by dental amalgam (a substance used for dental fillings) containing silver. The dental amalgam can invade nearby tissues in the mouth, leading to the appearance of flat, dark-blue lesions on the mucous membranes of the mouth.
Azure lunula is a symptom that can also be observed in patients with localised argyria; it can be detected by observing a colour change of the nail lunulae (the half-moon-shaped, white region on the nail), leading to bluish discolouration.
This is a condition that results from the accumulation of silver in the eye. It is characterised by the formation of small, dark lesions on the cornea of the eye, which can take on blue, green, and brown tones. The conjunctiva may also have blue pigmentation.
Diagnosis of argyria
Argyria is a rare condition that is diagnosed only after a thorough physical examination and an evaluation of the patient’s medical history to exclude any differential diagnoses.
The gold standard for diagnosis is to perform a skin biopsy of the affected region. Energy-dispersive X-ray spectroscopy (EDXS) is a non-invasive gold standard technique. Dermatoscopy (observing skin under a microscope) for localised argyria and slit-lamp biomicroscopy for argyrosis (argyria of the eyes) are other methods that are used to confirm the diagnosis.3
Blood and urine tests may be ordered to assess kidney function and to check for other signs of silver toxicity.
Treatment and management
Argyria is considered a permanent skin condition.1 However, some treatments may help reduce the intensity of the discoloration. These treatments include laser therapy, chemical peels, and dermabrasion, which involve removing the top layers of skin to reveal new, unblemished skin underneath. However, these treatments can be expensive and their efficacy is not always guaranteed.
The best way to prevent argyria is to avoid exposure to all forms of silver. This includes avoiding the use of silver-containing medication, as well as occupational exposure to silver dust or fumes. If you work in an industry that involves handling silver, be sure to take appropriate safety precautions, such as wearing protective clothing and equipment.
There is documentation of successful resolution of discolouration associated with argyria following seven laser treatments.4 Unfortunately, this resolution may only be temporary, with cases of argyria recurring approximately 1 year after laser therapy was performed.3,6
Another important management strategy is sun protection. Individuals with argyria are at an increased risk of developing skin cancer. So, it is important to minimise exposure to ultraviolet (UV) radiation. This can be achieved by wearing protective clothing, using sunscreen with a high sun protection factor (SPF), and avoiding outdoor activities during peak sun hours.
How is argyria diagnosed?
Diagnosis of argyria is typically based on clinical presentation and a history of exposure to silver or silver compounds. A skin biopsy may also be performed to confirm the presence of silver particles in the skin.1
How can I prevent argyria?
The best way to prevent argyria is to avoid exposure to silver or silver compounds. This includes avoiding the use of silver-containing dietary supplements or alternative medical treatments, as well as minimising occupational exposure to silver dust or fumes.1,2
Who is at risk of argyria?
Individuals who are exposed to silver or silver compounds on a regular basis are at the highest risk for developing argyria. This includes individuals who use silver-containing dietary supplements or alternative medical treatments, as well as those who work in occupations that involve exposure to silver dust or fumes.1,2
How common is argyria?
The exact number of people affected by argyria is uncertain, as it is a rare condition and there is limited data available. However, it is generally considered to be a very uncommon condition, with the majority of cases reported in medical literature being associated with occupational exposure to silver or excessive use of silver-containing products.1,2
When should I see a doctor?
If you have been exposed to silver or silver compounds and develop a blue-gray discoloration of the skin or other tissues, you should see a doctor for evaluation. Your doctor can help to confirm a diagnosis of argyria and provide guidance on management and treatment options.1,2
Argyria is a rare condition that is caused by prolonged exposure to silver or silver compounds. The condition is characterised by a permanent blue-gray discoloration of the skin and other tissues and can be associated with systemic symptoms in severe cases.
While there is no cure for argyria, management strategies, such as sun protection and cosmetic treatments, may help to reduce the discoloration linked to the condition. Prevention is key to avoiding argyria. Hence, individuals who are exposed to silver or silver compounds should take steps to minimise their exposure to the metal.
If you are concerned about your exposure to silver or develop symptoms of argyria, you should see a doctor for evaluation and guidance on management and treatment options.
- Molina-Hernandez AI, Diaz-Gonzalez JM, Saeb-Lima M, Dominguez-Cherit J. Argyria after Silver Nitrate Intake: Case Report and Brief Review of Literature. Indian J Dermatol. 2015 Sep-Oct;60(5):520. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601443/
- Thompson R, Elliott V, Mondry A. Argyria: permanent skin discoloration following protracted colloid silver ingestion. Case Reports. 2009 Feb 16;2009(feb04 1):bcr0820080606–6. https://casereports.bmj.com/content/2009/bcr.08.2008.0606
- Mota L, Dinis-Oliveira RJ. Clinical and Forensic Aspects of the Different Subtypes of Argyria. J Clin Med. 2021 May 13;10(10). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152497/
- Lencastre A, Lobo M, João A. Argyria -- case report. An Bras Dermatol. 2013 May-Jun;88(3):413-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3754374/
- 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 Jun;50(6):751-3. https://pubmed.ncbi.nlm.nih.gov/21595676
- Krase JM, Gottesman SP, Goldberg GN. Recurrence of Argyria Post Q-Switched Laser Treatment. Dermatol Surg. 2017 Oct;43(10):1308-1311. https://pubmed.ncbi.nlm.nih.gov/28296792