Argyrism: what is blue skin disease?

Argyrism or “blue skin disease” is a predominantly cutaneous condition characterized by coloring of the skin and mucous membranes in metallic blue. It is caused by a silver poisoning and its derivatives (nitrate, silver salts for example). The next episode of the fifth season of the Balthazar detective series broadcast on TF1 on February 16 will feature a character suffering from argyrism. “This condition is extremely rare. It is necessary to ingest very large quantities of silver to become poisoned. The cases described are very photogenic and therefore impressive, but they are atypical” explain it Dr Jérôme Langrand, toxicologist and head of the Paris poison control center. Does the blue skin disease really exists ? Which is the cause ? What are the other symptoms? What treatments recommend?

Definition: what is argyrism?

Argyrism or argyria is dermatosis related to chronic intoxication of the skin and mucous membranes with silver causing pigmentation of the skin with a metallic blue color. “After penetration, the silver particles are deposited in the dermis, in the sweat glands in an indelible way” indicates the French Society of Toxicology. We are talking argyrosis when the affection reaches the eyes. “The risk of developing this disease also depends on the type of exposure (breathing, skin contact, ingestion); duration and quantity“notes Dr. Jérôme Langrand.”In general, it is through the food route that there is the risk of toxicity, in particular via food supplements For example. Professions most exposed to money run only a low risk of acute toxicity of silver derivatives. Only silver nitrate, used in particular in dermatology as an antiseptic, can present a real risk in extremely large quantities.“adds the toxicologist doctor.

What are the symptoms of argyria?

The most suggestive symptom of argyria is the skin pigmentation of a silvery-blue color. “In the event of an acute incident of skin exposure to silver salt locally, a sort of blue/gray tattoo may form where your skin has come into contact with it. There may also be local effects such as skin burns or eye and throat irritation in case of ingestion of very large quantities of silver nitrate” develops Dr. Jérôme Langrand. In the most extreme cases but also the rarest, we can observe renal and neurological effects but the signs are regressive on stopping contact with money. In very high doses, silver nitrate poisoning can cause methemoglobinemia (too high level of methemoglobin in the blood) which corresponds to a lack of blood oxygenation.

What are the causes of argyria?

Exposure to too high doses of silver and in particular the ingestion of very large quantities of silver nitrate, can cause argyrism. “The silver then deposits in the skin, remains stored there in case of overdose and stains the skin. Normally, silver is eliminated through the kidneys and bile” notes the toxicologist doctor. “There may be a genetic predisposition for argyria” adds the French Society of Toxicology.

From what dose of money does one risk argyrism?

The total normal silver content of the human body is around 1 microgram per liter. Signs of argyria appear from 4 to 5 g, the lethal dose being evaluated between 50 and 500 mg/kg.

What are the sources of silver exposure?

►Professions. Inhalation of metal dust when working with metal. “Silver is a mineral used in various alloys and solders, in photography, in electrical equipment, in electroplating, in the manufacture of fungicides, in silverware, jewellery, coins and dentistry. Because of their bacteriostatic properties, silver salts are used for water disinfection and prophylaxis” noted The portal for rare diseases and orphan drugs.

► Food supplements in silver, natural products containing silver.

► Some water filter jugs. “With regard to silver, even if the concentrations observed in filtered water do not exceed the guideline value in water of 100 µg/L established by the World Health Organization (WHO), the Agency recommends that this value be examined in the light of recent toxicological data and emphasizes the need to consider the benefit/risk ratio of using silver for this type of use“emphasizes theHANDLES.

► Food. “Few data have been published on the silver content of food products, most of which seem to contain only traces (less than 1 mg/kg), except the mushrooms whose content can reach several hundred mg/kg” according to’WHO.

► Medications. “Sprays, nasal drops, colloidal silver eye drops or silver salts; antiseptic solutions for external use, stomach or skin dressings, dietary supplements, acupuncture needles or ligature threads used in abdominal surgery)” according to the French Society of Toxicology “Certain medicationscurrently abandoned, could be involved: ointments or eye drops with silver salts or colloidal silver” indicates the Medical Dictionary of the Academy of Medicine. Or even the silver nitrate pencils indicated in the treatment of warts.

“The pigmentation of the skin is irreversible”

The diagnosis of argyria is based on a clinical examination and silver assays via urine or blood test. A skin biopsy can possibly be made.

Are there treatments?

We do not have no specific treatment to this disease. Irreversible skin pigmentation. “In case of acute ingestion of silver nitrate, it is useful to drink salt water. Then we prescribe a specific treatment for nitrate ingestion (here silver). The best treatment is prevention, there is no proven beneficial effect of silver on health, so much theavoid to avoid risk of overdose“ emphasizes our interlocutor. Symptoms (other than skin discoloration) are regressive on cessation of ingestion or contact with silver.

Thanks to Dr Jérôme Langrand, toxicologist doctor and Head of the Paris poison control center.

Sources:

– Exposure to silver: two cases of argyria, Annals of Analytical Toxicology, 2011, French Society of Toxicology

– Argyrie, The portal for rare diseases and orphan drugs

– Filter jugs: ANSES reiterates the rules of good use, 13 March 2017, Anses

– Quality guidelines for drinking water, WHO