Silver Quiz

Argyria is a deramtosis which results from the accumulation of silver deposits in the skin, leading to a greyish-blue hue to the skin and fingernails. Nickel dermatitis has an appearance very similar to atopic dermatitis, or eczema. Vitiligo is an autoimmune disease that results in the elimination of melanocytes (likely T-cell mediated). Arsenic dermopathy is a dermatitis due to chronic arsenic exposure that is characterized by “due drops on a dusty road”.

Image curtesy of:

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;60(5):520.

Photographers who used film and expose their own prints have a risk for silver exposure.  Silver halides are embedded in the print paper. Silver halides in the areas of the print that are exposed to light are reduced by developing agents to silver metal, which is black in appearance. Historically, photographers may have had to make their own film plates and printing paper, which could lead to significant silver exposure. However, the  A gold miner would more likely be exposed to mercury, depending on the method of extraction. An organic chemist would be less likely to have a significant occupational exposure to silver salts. Crime scene specialist utilize luminol to detect the presence of “cleaned blood stains”; however, this compound does not contain silver and is an organic chemiluminescent molecule when excited with ultraviolet (black) light.

Historically, elemental silver and silver salts have been used for their bacteriocidal properties to disinfect drinking water. Silver ions inhibit bacterial enzymes, disrupts pH balance, and can also intercalate with DNA. The antibacterial properties of silver salts is why silver sulfadiazine is utilized for burn wound infection prophylaxis. Silver and silver salts play no role in prevention of alopecia. Digital camera light sensors do not contain silver, but rather usually contain silicon. The vast majority of coins in the world no longer contain silver.

Similar to the development of black and white film prints, silver halides are radicalized and reduced to elemental silver in the presence of light. This leads to precipitation of silver granules. These silver granules are blue-grey-silver appearing and tend to be more concentrated in the dermis of sun exposed areas. Sunlight does not further oxidize Ag¹⁺. Silver free radicals are not the cause of hyperpigmentation. Furthermore, hyperpigmentation would not result in the characteristic skin pigment tone of argyria. Silver has not been shown to be integrated into cytochrome-p oxidase.

Out of all the above treatment options, only YAG laser treatment has been shown to effectively restore normal skin pigmentation in patients suffering from argyria. There are no definitive medical therapies that have been shown to reduce silver granules in the dermis.