Case and Research Letters
Localized Cutaneous Argyria: A Report of 2 Cases
Argiria cutánea localizada. A propósito de 2 casos
J. Garcias-Ladaria
, P. Hernandez-Bel, J.L. Torregrosa-Calatayud, A. Martínez-Aparicio
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Garcias-Ladaria, P. Hernandez-Bel, J.L. Torregrosa-Calatayud, A. Martínez-Aparicio" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Garcias-Ladaria" "email" => array:1 [ 0 => "jgarcila@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Hernandez-Bel" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Torregrosa-Calatayud" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Martínez-Aparicio" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Argiria cutánea localizada. A propósito de 2 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1197 "Ancho" => 1608 "Tamanyo" => 195844 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A and B, The first patient presented several blue-gray macules on the dorsum of the fourth finger of the right hand and on the palmar surface of the fifth finger of the right hand. C, Dermoscopy revealed a homogeneous blue-gray pattern. D, The second patient presented similar lesions on the dorsum of both hands.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Argyria is a rare disease caused by silver deposition in the body. Most reports of occupational argyria in the literature describe the generalized form.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We report on 2 patients who developed localized argyria after more than 30 years of contact with silver. The clinical appearance of these lesions requires us to make a differential diagnosis including deep melanocytic lesions, especially melanoma metastases.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first patient was a 75-year-old man with no previous history of interest who presented with asymptomatic blue macules that had begun to appear 5-10 years previously on the dorsum of the fourth finger of the right hand and on the palmar surface of the fifth finger of the right hand (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, A and B). Dermoscopy revealed lesions with a homogeneous blue pattern (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The second patient was a 70-year-old man who also presented with blue-gray macules on the dorsum of both hands that had begun to appear 5 years previously (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). Biopsy disclosed multiple dark brown strands and granules with a periadnexal distribution around the secretory coils of the sweat glands and an interstitial distribution with deposits along the elastic fibers of the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, A, B, and C). Staining for melanocytes was negative. Dark-field microscopy revealed characteristic brilliant specks (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D). After more exhaustive questioning, both patients stated that they had worked as jewelers for more than 30 years and habitually handled silver. They were diagnosed with localized cutaneous argyria and, after opting not to receive treatment, remain under follow-up. Two years after diagnosis, no changes have been detected in the lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Argyria is an uncommon condition today, especially since silver-containing systemic medication, which was once used to treat a variety of conditions (including syphilis), is no longer prescribed.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Nevertheless, a series of mechanisms has been described in recent years by which silver can unintentionally enter the body through the skin, including the use of earrings, body piercing, dental amalgam, topical silver salts, or acupuncture needles.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–9</span></a> Prolonged occupational exposure to silver occurs in individuals working in the manufacturing industry and photographic processing, as well as silversmiths and goldsmiths.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Clinically, argyria is classed as generalized or localized. Generalized argyria is produced by the ingestion or inhalation of silver compounds that subsequently reach internal organs and the skin, where they cause permanent diffuse blue-gray coloration in photoexposed areas.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Localized argyria is caused by direct external contact with silver; the most commonly affected areas are the hands, eyes, and the mucosas. The mechanism of penetration is unknown, although it is thought to be via the eccrine sweat ducts, since the metal is most concentrated around the secretory portion of the gland.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The fact that accumulation of silver does not respond to chelators, as well as the relatively low frequency of systemic argyria in patients with intact skin who come into contact with silver, suggests that silver is deposited in the dermis in a chemically stable and apparently inert form.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> Physical examination reveals multiple asymptomatic blue-gray macules with a nonspecific homogeneous blue pattern on dermoscopy. Histology reveals apparently normal skin. However, increased magnification reveals multiple brown-gray strands and granules distributed between collagen fibers, within histocytes, in the basement membrane of the eccrine sweat glands, and along the elastic fibers of the dermis in a pattern that resembles chains of streptococci. Under polarized light microscopy, the metallic granules are brilliantly refractile and produce the characteristic “starry sky” image.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In chrysiasis (gold deposits in tissue), the granules are typically larger and present red-orange birefringence. Bismuth deposits are positive on Christeller-Komaya staining. The definitive diagnosis is made using electron microscopy, x-ray microanalysis, or other more complex histochemical methods that make it possible to identify the chemical composition of the granules.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, we present 2 cases of localized occupational argyria occurring after years of exposure to silver products. The clinical appearance and dermoscopy findings required other blue-colored lesions, particularly melanoma metastases, to be ruled out. Argyria is probably underdiagnosed, and some authors report that up to 40% of exposed individuals can eventually develop the condition.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A detailed history will help to orientate the diagnosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Garcias-Ladaria J, et al. Argiria cutánea localizada. A propósito de 2 casos. Actas Dermosifiliogr. 2013;104:253–4.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1197 "Ancho" => 1608 "Tamanyo" => 195844 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A and B, The first patient presented several blue-gray macules on the dorsum of the fourth finger of the right hand and on the palmar surface of the fifth finger of the right hand. C, Dermoscopy revealed a homogeneous blue-gray pattern. D, The second patient presented similar lesions on the dorsum of both hands.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1218 "Ancho" => 1623 "Tamanyo" => 300299 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histology revealed the presence of dark brown strands and granules with a periadnexal distribution (A) and along the elastic fibers to create an image resembling chains of streptococci (B and C) (hematoxylin-eosin, original magnification ×200). Dark-field microscopy shows the characteristic “starry sky” image (D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Localized argyria in an antique restorer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Kapur" 1 => "G. Landon" 2 => "R.C. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 16 | 15 | 31 |
| 2024 Octubre | 93 | 54 | 147 |
| 2024 Septiembre | 125 | 41 | 166 |
| 2024 Agosto | 140 | 69 | 209 |
| 2024 Julio | 137 | 48 | 185 |
| 2024 Junio | 100 | 51 | 151 |
| 2024 Mayo | 103 | 46 | 149 |
| 2024 Abril | 140 | 24 | 164 |
| 2024 Marzo | 136 | 36 | 172 |
| 2024 Febrero | 101 | 39 | 140 |
| 2024 Enero | 95 | 38 | 133 |
| 2023 Diciembre | 114 | 29 | 143 |
| 2023 Noviembre | 92 | 28 | 120 |
| 2023 Octubre | 95 | 30 | 125 |
| 2023 Septiembre | 94 | 25 | 119 |
| 2023 Agosto | 65 | 17 | 82 |
| 2023 Julio | 84 | 34 | 118 |
| 2023 Junio | 83 | 25 | 108 |
| 2023 Mayo | 67 | 29 | 96 |
| 2023 Abril | 55 | 16 | 71 |
| 2023 Marzo | 65 | 34 | 99 |
| 2023 Febrero | 60 | 30 | 90 |
| 2023 Enero | 62 | 26 | 88 |
| 2022 Diciembre | 62 | 49 | 111 |
| 2022 Noviembre | 42 | 32 | 74 |
| 2022 Octubre | 40 | 29 | 69 |
| 2022 Septiembre | 54 | 42 | 96 |
| 2022 Agosto | 23 | 32 | 55 |
| 2022 Julio | 29 | 40 | 69 |
| 2022 Junio | 32 | 24 | 56 |
| 2022 Mayo | 47 | 43 | 90 |
| 2022 Abril | 86 | 58 | 144 |
| 2022 Marzo | 68 | 63 | 131 |
| 2022 Febrero | 56 | 30 | 86 |
| 2022 Enero | 52 | 45 | 97 |
| 2021 Diciembre | 50 | 68 | 118 |
| 2021 Noviembre | 61 | 52 | 113 |
| 2021 Octubre | 49 | 64 | 113 |
| 2021 Septiembre | 31 | 43 | 74 |
| 2021 Agosto | 38 | 28 | 66 |
| 2021 Julio | 33 | 38 | 71 |
| 2021 Junio | 33 | 29 | 62 |
| 2021 Mayo | 37 | 40 | 77 |
| 2021 Abril | 35 | 88 | 123 |
| 2021 Marzo | 54 | 23 | 77 |
| 2021 Febrero | 65 | 27 | 92 |
| 2021 Enero | 31 | 26 | 57 |
| 2020 Diciembre | 32 | 19 | 51 |
| 2020 Noviembre | 29 | 20 | 49 |
| 2020 Octubre | 22 | 15 | 37 |
| 2020 Septiembre | 65 | 12 | 77 |
| 2020 Agosto | 81 | 11 | 92 |
| 2020 Julio | 46 | 17 | 63 |
| 2020 Junio | 38 | 22 | 60 |
| 2020 Mayo | 31 | 14 | 45 |
| 2020 Abril | 14 | 19 | 33 |
| 2020 Marzo | 36 | 21 | 57 |
| 2020 Febrero | 5 | 2 | 7 |
| 2020 Enero | 0 | 5 | 5 |
| 2019 Diciembre | 0 | 6 | 6 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 0 | 2 | 2 |
| 2019 Julio | 0 | 2 | 2 |
| 2019 Junio | 0 | 1 | 1 |
| 2019 Mayo | 1 | 20 | 21 |
| 2019 Abril | 0 | 1 | 1 |
| 2019 Marzo | 0 | 3 | 3 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Marzo | 4 | 1 | 5 |
| 2018 Febrero | 61 | 2 | 63 |
| 2018 Enero | 60 | 8 | 68 |
| 2017 Diciembre | 62 | 8 | 70 |
| 2017 Noviembre | 46 | 5 | 51 |
| 2017 Octubre | 58 | 8 | 66 |
| 2017 Septiembre | 29 | 19 | 48 |
| 2017 Agosto | 33 | 9 | 42 |
| 2017 Julio | 34 | 8 | 42 |
| 2017 Junio | 48 | 9 | 57 |
| 2017 Mayo | 39 | 5 | 44 |
| 2017 Abril | 42 | 12 | 54 |
| 2017 Marzo | 29 | 3 | 32 |
| 2017 Febrero | 92 | 4 | 96 |
| 2017 Enero | 66 | 7 | 73 |
| 2016 Diciembre | 61 | 12 | 73 |
| 2016 Noviembre | 58 | 13 | 71 |
| 2016 Octubre | 107 | 24 | 131 |
| 2016 Septiembre | 66 | 9 | 75 |
| 2016 Agosto | 70 | 14 | 84 |
| 2016 Julio | 56 | 5 | 61 |
| 2016 Junio | 6 | 8 | 14 |
| 2016 Mayo | 4 | 5 | 9 |
| 2016 Abril | 3 | 13 | 16 |
| 2016 Marzo | 5 | 1 | 6 |
| 2016 Febrero | 6 | 1 | 7 |
| 2016 Enero | 11 | 2 | 13 |
| 2015 Diciembre | 5 | 2 | 7 |
| 2015 Noviembre | 9 | 3 | 12 |
| 2015 Octubre | 4 | 2 | 6 |
| 2015 Septiembre | 7 | 4 | 11 |
| 2015 Agosto | 16 | 3 | 19 |
| 2015 Julio | 169 | 119 | 288 |
| 2015 Junio | 101 | 10 | 111 |
| 2015 Mayo | 105 | 32 | 137 |
| 2015 Abril | 115 | 16 | 131 |
| 2015 Marzo | 77 | 3 | 80 |
| 2015 Febrero | 80 | 3 | 83 |
| 2015 Enero | 52 | 5 | 57 |
| 2014 Diciembre | 54 | 1 | 55 |
| 2014 Noviembre | 51 | 4 | 55 |
| 2014 Octubre | 66 | 4 | 70 |
| 2014 Septiembre | 69 | 1 | 70 |
| 2014 Agosto | 63 | 7 | 70 |
| 2014 Julio | 62 | 4 | 66 |
| 2014 Junio | 62 | 3 | 65 |
| 2014 Mayo | 65 | 6 | 71 |
| 2014 Abril | 56 | 2 | 58 |
| 2014 Marzo | 60 | 9 | 69 |
| 2014 Febrero | 52 | 12 | 64 |
| 2014 Enero | 54 | 6 | 60 |
| 2013 Diciembre | 48 | 10 | 58 |
| 2013 Noviembre | 32 | 6 | 38 |
| 2013 Octubre | 52 | 8 | 60 |
| 2013 Septiembre | 28 | 2 | 30 |
| 2013 Agosto | 28 | 6 | 34 |
| 2013 Julio | 5 | 4 | 9 |
| 2013 Junio | 6 | 4 | 10 |
| 2013 Mayo | 1 | 4 | 5 |
| 2013 Abril | 4 | 6 | 10 |
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