Silver blue skin - Argyria - causes, symptoms and treatment

Bluish skin discoloration > Silver blue skin - Argyria

What is argyria?

The rare blue skin disorder, Argyria, is due to the presence of silver in the skin.

Argyria disease results from protracted excessive exposure or ingestion of metallic silver, silver salts and silver compounds. There are two types of argyria disease. Ingestion of silver salts and silver compounds for prolonged period causes generalized (universal) form of argyria ailment whereas continuous localized excessive contacts with silver and its compounds causes localized argyria disease, affecting only the parts of the body which are in direct contact with blue or blue grey skin discoloration.

Apart from skin, sclerae, conjunctiva, oral mucosa, tongue, other mucous membranes, nail beds, gums and internal visceral organs also may get affected with discoloration. Melis Palamar, MD et al have recorded that the content and color of the tears can be affected by argyria. A patient with bilateral black tears (melanodacryorrhea) was found to have bilateral argyrosis of the conjunctiva due to occupational inhalation of silver compounds.

Silver has a wide variety of uses as jewelry, silverware, dental fillings, antibacterial agent and light sensitive coating of photo films. There are many medical uses of compounds of silver as incorporation into wound dressings, as antiseptic applications and as disinfectants in medical appliances. There is a school of alternative medicine advocating the use of colloidal silver as a cure for many ailments like AIDS and dermatitis. However the efficacy of these colloidal compounds in medical treatment is still under dispute. Bluish skin discoloration
Image of generalized argyria [Image by Herbert Fred, Hendrik van Dijk/Images of Memorable Cases: Case 4/ http://cnx.org/content/m14962/1.3/(CC-BY 2.0)]

Argyria causes and risk factors

• Prolonged exposure to dust containing particles of this metal, as in silver mining causes argyria.
• Prolonged exposure of workers in factories manufacturing jewelry and silverware may cause this blue skin disorder.
• Dental fillings made of this metal causes argyria in some cases. Silver sutures used in surgeries were one of the causes of this blue skin disease.
• Prolonged use of medications, drugs and supplements containing silver, its compounds or colloidal silver causes this disease.
• Homemade concoctions with this metal for treating diseases may cause argyria.
• Nasal sprays, nose drops, topical applications, tattoo colors and acupuncture and piercing needles containing  compounds of this metal can cause localized argyria.
• Lee SM and Lee SH of Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea, reported a case wherein use of silver nitrate (AgNO3) to treat oral ulcers for ten years had caused generalized argyria.
• In a study in Japan it was found that habitual use of a breath freshener coated with silver had caused this disorder in some people.

Symptoms of argyria

• On prolonged exposure to silver or its salts if there is blue  or blue-grey skin discoloration, it is a clear symptom of argyria.
• Gums getting blue grey discoloration is another symptom of argyria.
• Blue discoloration of skin of the hands and face turning darker on exposure to sunlight is another symptom of argyria.
• Normally symptoms of argyria do not develop immediately. Up to 1 mg of silver is found in human body. Symptoms of this blue discoloration usually occurs when there is accumulation of four grams. In some people the symptoms show up when there is twenty grams or more of this metal in the body.

Diagnosis of argyria

• Causes of blue skin discoloration can be due to different diseases and a differential diagnosis may be necessary to pinpoint this disease.
• If the blue or blue grey skin darken when exposed to sunlight it could be diagnosed as a case of argyria.
• Biopsy of the skin also reveals the presence of silver deposits as blue-brown-black granules, singly or in clusters in the basement membrane zone surrounding the sweat glands, sebaceous glands and surrounding connective tissues.
• Silver is generally detected in the granular material in X-ray microanalysis assay.

Argyria treatment and prevention

• The treatment of this disease starts with immediate stoppage of exposure and seeking medical help.
• The doctor may prescribe topical hydroquinone ointment to reduce the blue skin patches in the case of localized argyria.
• Laser treatment has been successfully carried out in some cases to reduce the intensity of argyria blue patches.
• In some people exposure to high levels of silver particles in air can cause breathing problems, throat irritation and lung  irritation. A qualified doctor must be approached for treatment.
• Similarly contact skin allergies may occur in some people on exposure to this metal and a dermatologist must be consulted for treatment.
• For this generalized blue disorder there is no successful treatment.
• Avoiding sun exposure and using sunscreen helps in preventing this skin discoloration getting worse.
• Chelation therapy and dermabrasion have been tried and found ineffective as treatment for argyria and in removing metal deposits from the body.
• For those working in factories manufacturing various products of silver, wearing protective gear may help in preventing this blue discoloration.
• Environmental Protection Agency (EPA) recommends that the concentration of silver in drinking water not exceed 0.10 milligrams per liter of water (0.10 mg/L) because of the skin discoloration that may occur.

Although silver blue skin pigment changes are permanent, argyria disease usually has no adverse effect on health. Topic of interest:
Stress and skin problems like rashes

Mongolian blue spot birthmark - Dermal Melanocytosis

Blue skin discoloration > Mongolian spot

Also known as Congenital Dermal Melanocytosis, Mongolian blue spot, is a benign asymptomatic birthmark present at birth or appears shortly thereafter. It is also known as Mongolian spot and Mongolian birthmark.

This pigmented macule is flat and irregular in shape with wavy and indistinct border. Mongolian condition is usually present as multiple patches or one single large patch in lumbosacral area and buttocks; it may also occur on shoulders and other parts of the body, usually sparing head, face, palms and soles.

Picture of blue skin coloration Mongolian blue spot
image by: Flickr/mliu92/CC BY-NC-SA 2.0

   The Mongolian spot spontaneously regresses, fades and disappears by the age of 3 or 4 years. It rarely persist up to puberty. As this macule is harmless and disappears on its own, no treatment is necessary. Blue and blue-green are the most common colors. However grey, slate-grey, blue-grey, grey-black and brown coloration are also encountered.

Image of blue skin pigmentation - Mongolian blue spot birthmarkpicture by: Flickr/GeoWombats/CC BY 2.0

   This Mongolian condition is congenital in origin and involves skin. The blue skin discoloration is due to dense presence of melanocytes, the pigment cells containing melanin. Though normally melanocytes are present in epidermal layer of skin, in these Mongolian spots, they are present in deeper dermis layer of skin. Histological studies reveal the presence of widely placed dendritic melanocytes in lower reticular dermis. These melanocytes are found between bundles of collagen. In contrast to blue nevus wherein the dermis is fibrotic, the collagen is unaltered in Mongolian spot.

   Erwin Bälz (13 January 1849 – 31 August 1913) discovered and named "Mongolian spot". He was a German and was a personal physician to the Japanese Imperial Family. He was the founder of modern medicine in Japan. He thought that the blue macules found in Japanese babies are characteristics of the Mongoloid races and called them Mongolian spots.

However Mongolian macule is highly prevalent among people of East and South-east Asian origin, East Africans and Native Americans (85-100%). People of Turkish and Hispanic origins also have high degree of prevalence (50-70%). It is rarer among Caucasian (1-10%) and other races. Mongolian pigment condition is unrelated to gender and both female and male infants are equally predisposed. Sometimes Mongolian spot may be mistaken for bruise due to child abuse.

Neural crest, melanocytes and Mongolian spot

   A brief knowledge of fetal development is necessary for understanding how Mongolian blue spot is formed. During gastrulation stage, fetus undergoes massive reorganisation by the processes called invagination, ingression and involution. From being a spherical ball of cells (blastula) it is transformed into multilayer  organism. Now a neural plate is formed by thickening of the ectoderm layer. The edges of the plate fold and raise to meet at the middle to form neural tube and epidermis. the cells at the tips of the neural folds and adjoining epidermis form neural crest cells.

Neural crest formation and cells migration

   Neural crest is a pluripotent population of transient cells with multiple fates. They detach and migrate extensively throughout the fetus. Stopping at different locations, these pluripotent cells give rise to a wide array of derivatives. Some of these cells become melanocytic progenitors, getting restricted to melanogenic lineage, due to the process of melanoblast specification by various transcription factors and extracellular signalling pathways. These melanocytic progenitors are also known as melanoblasts and are unpigmented. However they have potential to produce melanin. During their migration from neural crest to epidermis, some of these melanoblasts get entrapped in dermis layer, transform to melanocytes and start producing melanin. The melanin pigment in deeper dermal areas of skin gives the blue colored appearance of Mongolian spot.

Topic of interest:
Stress and skin problems like rashes

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