Editing Argyria

{{other uses}}
{{distinguish|agyria|the Blue Fugates}}
{{Infobox medical condition (new)
| name            = Argyria
| synonyms        = Argyrosis
| image           = Argyria 2b.jpg
| alt             = For many years, man had used nose drops containing silver. His skin biopsy showed silver deposits in the dermis, confirming the diagnosis of argyria.
| caption         = Generalized argyria in a 92-year-old male.
| field           = [[Dermatology]]
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'''Argyria''' or '''argyrosis''' is a [[Medical condition|condition]] caused by excessive exposure to chemical compounds of the element [[silver]], or silver dust.<ref name="Andrews">{{cite book |first1=William D. |last1=James |first2=Timothy G. |last2=Berger |first3=Dirk M. |last3=Elston |first4=Richard B. |last4=Odom |title=Andrews' diseases of the skin: clinical dermatology |publisher=Saunders Elsevier |year=2006 |page=858 |isbn=0-7216-2921-0 |oclc=62736861}}</ref> The most dramatic symptom of argyria is that the [[skin]] turns [[blue]] or [[blue-gray]], and is usually most prominent in sun-exposed areas of the skin. It may take the form of ''generalized argyria'' or ''local argyria''. Generalized argyria affects large areas over much of the visible surface of the body. Local argyria shows in limited regions of the body, such as patches of skin, parts of the [[mucous membrane]], or the [[conjunctiva]].

The terms ''argyria'' and ''argyrosis'' have long been used interchangeably,<ref>Guttmann, Paul. tr. by A. Napier. A handbook of physical diagnosis comprising the throat, thorax, and abdomen. 1879. May be downloaded from https://archive.org/details/ahandbookphysic02guttgoog</ref> with ''argyria'' being used more frequently. ''Argyrosis'' has been used particularly in referring to argyria of the conjunctiva, but the usage has never been consistent and cannot be relied on except where it has been explicitly specified.<ref>Fox, Lawrance Webster. A practical treatise on ophthalmology. Pub. D. Appleton and company NY. 1920. May be downloaded from https://archive.org/details/apracticaltreat00foxgoog</ref> The term is from the {{langx|grc|ἄργυρος}} ({{Lang|grc-latn|argyros}}, 'silver').

==Pathophysiology==

In humans and other animals, chronic intake of silver products commonly leads to the gradual accumulation of silver compounds in various parts of the body.<ref name="FungBowen1996">{{cite journal |vauthors=Fung MC, Bowen DL |title=Silver products for medical indications: risk-benefit assessment |journal=Journal of Toxicology. Clinical Toxicology |volume=34 |issue=1 |pages=119–26 |year=1996 |pmid=8632503 |doi=10.3109/15563659609020246}}</ref>  As in [[analog photography]] (where silver is used for its sensitivity to light), exposure of pale or colorless silver compounds to sunlight decomposes them to silver metal or [[silver sulfide]]s. Commonly these products deposit as microscopic particles in the skin, in effect a dark pigment. This condition is known as argyria or argyrosis.

Chronic intake also may lead to silver pigments depositing in other organs exposed to light, particularly the [[human eye|eyes]].<ref name="Lansdown2006">{{cite book |author=Lansdown AB |title=Biofunctional Textiles and the Skin |chapter=Silver in health care: antimicrobial effects and safety in use |volume=33 |pages=17–34 |year=2006 |pmid=16766878 |doi=10.1159/000093928 |series=Current Problems in Dermatology |isbn=3-8055-8121-1}}</ref> In the conjunctiva this is not generally harmful, but it also may affect the lens, leading to serious effects.

Localized argyria often results from [[Topical medication|topical]] use of substances containing silver, such as some kinds of [[eye drop]]s. Generalized argyria results from chronically swallowing or inhaling silver compounds, either for home medicinal purposes or as a result of working with silver or silver compounds.<ref name="pmid-16021155">{{cite journal |vauthors=Brandt D, Park B, Hoang M, Jacobe HT |title=Argyria secondary to ingestion of homemade silver solution |journal=Journal of the American Academy of Dermatology |volume=53 |issue=2 Suppl 1 |pages=S105–7 |date=August 2005 |pmid=16021155 |doi=10.1016/j.jaad.2004.09.026}}</ref>

While silver is potentially toxic to humans at high doses, the risk of serious harm from low doses, given over a short term, is small. Silver is used in some medical appliances because of its anti-microbial nature, which stems from the [[oligodynamic effect]]. Chronic ingestion or inhalation of silver preparations (especially [[colloidal silver]]) can lead to argyria in the skin and other organs. This is not life-threatening but is considered by most to be cosmetically undesirable.<ref name="FungBowen1996"/><ref name="Lansdown2006"/><ref>{{cite web | url=https://www.atsdr.cdc.gov/toxfaqs/tfacts146.pdf | title=ToxFAQsTM for Silver | date=July 1999 }}</ref><ref>{{cite web | url=https://www.atsdr.cdc.gov/toxprofiles/tp146-c1.pdf | title=Public Health Statement: Silver | publisher=ATSDR}}</ref>

The [[reference dose]], published by the [[United States Environmental Protection Agency]] in 1991, which represents the estimated daily exposure that is unlikely to incur an appreciable risk of deleterious effects during a lifetime, is 5&nbsp;μg/(kg·d).<ref name="FungBowen1996"/>

Argyria worsens and builds up as exposure to silver continues, and does not resolve once exposure stops because the silver atoms cannot be removed from the skin and other tissues.

== History ==
Since at least the mid-19th century, doctors have known that silver or silver compounds can cause some areas of the skin and other body tissues to turn grey or blue-gray.<ref>{{cite book|title=London Medical Gazette: Or, Journal of Practical Medicine|url=https://books.google.com/books?id=eIQM_vME0QgC&pg=PA791|access-date=13 July 2013|year=1843|pages=791–}}</ref><ref>{{cite book|title=The Cincinnati Lancet and Observer|url=https://books.google.com/books?id=B-QiAQAAMAAJ&pg=PA141|access-date=13 July 2013|year=1859|publisher=E.B. Stevens|pages=141–}}</ref>  Argyria occurs in people who ingest or inhale silver in large quantities over a long period (several months to many years). People who work in factories that manufacture silver products can also breathe in silver or its compounds. In the past, some of these workers have become argyric. However, the level of silver in the air and the length of exposure that caused argyria in these workers is not known. Historically, colloidal silver, a [[liquid]] [[suspension (chemistry)|suspension]] of [[microscopic]] silver particles,<!--A [[colloid]] is defined as particles which remain suspended without forming an [[Ionic liquid|ionic]] or dissolved solution.--> was also used as an internal medication to treat a variety of diseases. In the 1940s, they were overtaken by the use of pharmaceutical antibiotics, such as [[penicillin]].

==Society and culture==
[[File:Plata Coloidal Super Tyndall Effect.jpeg|thumb|Colloidal silver is illegally marketed as a medicine, but it is not proven to treat any condition, and may interfere with the functioning of some medications, such as antibiotics and thyroxine.<ref>{{cite web |title=Colloidal Silver |url=https://www.nccih.nih.gov/health/colloidal-silver |website=NCCIH |language=en}}</ref>]]
A prominent case involving the ingestion of colloidal silver was that of American [[Stan Jones (Libertarian politician)|Stan Jones]], a [[Libertarian Party (United States)|Libertarian]] candidate for the [[United States Senate]] in 2002 and 2006.<ref name="Post">{{cite news|url=https://www.washingtonpost.com/archive/lifestyle/2006/11/12/a-true-blue-libertarian-span-classbankheadstan-jones-the-also-ran-who-changed-the-hue-of-politicsspan/f065de8d-16c0-47ef-8451-1a67c8291f80/|title=A True Blue Libertarian|author=[[Blaine Harden]]|newspaper=[[The Washington Post]]|date=November 12, 2006|accessdate=August 10, 2021}}</ref><ref name="Spoon">{{cite web|url=https://www.npr.org/templates/story/story.php?storyId=128588187|title=Fun And Intrigue With The Periodic Table|author=[[All Things Considered]]|publisher=[[National Public Radio]]|date=July 17, 2010|accessdate=August 10, 2021}}</ref> The peculiar coloration of his skin was featured prominently in media coverage of his unsuccessful campaign, though his supporters contended that the best-known photo was "doctored".<ref>{{Cite news |last=Sullivan |first=Robert |date=2002-11-03 |title=A Case of the Blues |url=https://www.newyorker.com/magazine/2002/11/11/a-case-of-the-blues |access-date=2024-01-07 |work=The New Yorker |language=en-US |issn=0028-792X}}</ref><!-- Unreliable source removed: <ref name="StanJonesLetter">{{cite web | last=Kotynski | first=Tom | title=Colloidal Silver News - Senate candidate sports a 'healthy' shade of blue | website=Colloidal Silver News, Generators, Facts and More | date=30 September 2002 | url=http://www.csfacts.com/pages/jones.html | access-date=13 December 2021}}</ref> --> Jones promised that he was not using his silvery complexion as a gimmick. His purposeful consumption of [[colloidal silver]] was a self-prescribed measure undertaken in response to fears that the [[Year 2000 problem|Y2K problem]] would make antibiotics unavailable, an event that did not occur.<ref name="Spoon" /><ref name="StanJonesLetter">{{cite web | last=Kotynski | first=Tom | title=Colloidal Silver News - Senate candidate sports a 'healthy' shade of blue | website=Colloidal Silver News, Generators, Facts and More | date=30 September 2002 | url=http://www.csfacts.com/pages/jones.html | access-date=13 December 2021}}</ref> He is reported to have said that given the chance to go back, he would do it again.<ref name="Spoon" /> He maintains that his good health, except for the unusual skin tone, is the result of his use of colloidal silver.<ref name="StanJonesLetter"/>

In 2007, press reports described [[Paul Karason]], an [[Americans|American]] man whose skin gradually turned [[blue]] after he took a homemade [[silver chloride]] colloid and used a silver salve on his face in an attempt to treat problems with his [[Paranasal sinuses|sinuses]], [[dermatitis]], [[Gastroesophageal reflux disease|acid reflux]] and other issues.<ref name="KarasonABC">{{cite news|url=https://abcnews.go.com/Health/MedicalMysteries/story?id=5489997&page=1#.T0axNPEge_c |title=Feeling Blue Over Skin Color | publisher=ABC News |author=Joseph Angier |date=August 20, 2008 |access-date=December 13, 2021}}</ref><ref>{{cite web|title=Why This Man Turned Blue|url=http://www.nbcnews.com/id/21134540/vp/22534645#22534645|archive-url=https://web.archive.org/web/20150802000040/http://www.nbcnews.com/id/21134540/vp/22534645#22534645|url-status=dead|archive-date=August 2, 2015|website=Today|publisher=NBC News|access-date=19 November 2015|date=7 January 2008}}</ref> At the time of the reports, Karason maintained his belief in silver's effectiveness and continued to take it, albeit in smaller doses. He died in 2013 of a [[heart attack]]; "a cause of death was not immediately known", but according to Jo Anna Karason, his estranged wife, "Paul Karason had suffered heart problems for years. He was a heavy smoker, despite undergoing [[triple bypass surgery]] about five years ago".<ref>{{cite web|url=https://abcnews.go.com/Health/internet-sensation-papa-smurf-dies-blue-people-live/story?id=20368758|title=Internet Sensation 'Papa Smurf' Dies, Other Blue People Live On|date=25 September 2013|work=ABC News|access-date=26 October 2017}}</ref><ref>{{cite web|url=https://www.today.com/health/real-life-blue-man-dies-after-heart-attack-stroke-4B11243410|title=Real-life 'Blue Man' dies after a heart attack, stroke|date=24 September 2013|work=Today|access-date=30 January 2021}}</ref>

Rosemary Jacobs is a prominent activist against [[alternative medicine]]. As a child, Jacobs was treated for allergies with nose drops that contained colloidal silver and developed argyria as a result.<ref>{{cite web|last1=Jacobs|first1=Rosemary|title=My Story|url=http://www.rosemaryjacobs.com/rose2.html|website=Rosemary's Story|access-date=19 November 2015|date=1998}}</ref> Jacobs came to international attention after Paul Karason was on ''[[Today (American TV program)|The Today Show]]'' in 2008.<ref>{{cite news|title=Woman who turned silver warns of dangers of internet medicines|url=https://www.telegraph.co.uk/news/newstopics/howaboutthat/2687985/Woman-who-turned-silver-warns-of-dangers-of-internet-medicines.html|website=The Telegraph|access-date=19 November 2015|date=5 September 2008}}</ref><ref>{{cite web|last1=Hit Blames on Colloidal Silver|url=http://www.webmd.com/news/20080905/colloidal-silver-faq|website=WebMD|access-date=19 November 2015|date=5 September 2008|title=Colloidal Silver: FAQ}}</ref> From 2010 to 2013, Jacobs posted about topics in health fraud, particularly [[naturopathy]], on her blog.<ref>{{cite web|last1=Jacobs|first1=Rosemary|title=Rosemary's Medical Blog|url=http://rosemary-jacobs.blogspot.com/|access-date=19 November 2015}}</ref><!-- self-published, but permitted as an about-self source -->

==Possible implications==
Although research is still not definitive, the literature has suggested that argyria can cause a decrement in [[kidney]] function. Additionally, a lack of [[night vision]] may be present.<ref>{{cite journal |vauthors=Rosenman KD, Moss A, Kon S |title=Argyria: clinical implications of exposure to silver nitrate and silver oxide. |journal=Journal of Occupational and Environmental Medicine |volume=21 |issue=6 |pages=430–435 |date=June 1979 |pmid=469606}}</ref>

== See also ==
* [[Amalgam tattoo]]
* {{annotated link|Bismuthia}}
* {{annotated link|Carotenodermia}}
* {{annotated link|Chrysiasis}}
* {{annotated link|Methemoglobinemia}}, another condition known for causing blue skin coloration

== References ==
{{Reflist}}

== External links ==
{{Medical resources
|  DiseasesDB     = 29790 
|  ICD10          = {{ICD10|T|56|8|t|51}}, L81.8 ([[ILDS]] L81.854) 
|  ICD9           = {{ICD9|985.8}} 
|  ICDO           = 
|  OMIM           = 
|  MedlinePlus    = 
|  eMedicineSubj  = derm 
|  eMedicineTopic = 595 
|  MeshID         = D001129
| Orphanet=60014
}}
{{Commons category|Argyria (illness)}}
* {{cite web |url= https://www.atsdr.cdc.gov/PHS/PHS.asp?id=537&tid=97 |title= Public Health Statement for Silver |date= December 1990 |publisher= [[Centers for Disease Control]]  |access-date= February 24, 2007}}
* [http://rosemaryjacobs.com/rose2.html "Rosemary's Story."] Rosemary Jacobs explains her argyria; includes photographs.  Accessed February 24, 2007.
* [http://dermatology.cdlib.org/111/case_reports/argyria/wadhera.html "Systemic Argyria Associated With Ingestion of Colloidal Silver."] by  Akhil Wadhera, MD and Max Fung, MD.  ''Dermatology Journal Online.''  Accessed February 24, 1997.
* [https://abc30.com/archive/5843725/ "Blue Man Seeks Acceptance"] about another victim of argyria due to colloidal silver.
* [https://web.archive.org/web/20071225075852/http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/12/20/nblue120.xml&CMP=ILC-mostviewedbox "Man Turns Blue"], by Duncan Hooper, telegraph.co.uk, Dec. 21, 2007.
* [https://web.archive.org/web/20130129090138/http://www.nbcnews.com/id/21134540/ "This Man Turned Blue (video)"], NBC Today Show, [[Matt Lauer]] interview, aired January 7, 2008.
* [http://www.rsc.org/chemistryworld/2012/11/chemistry-blue-man-argyria-colloidal-silver Chemistry behind the 'blue man' unlocked"], by Josh Howgego, [[Chemistry World]], 1 November 2012.

{{Poisoning and toxicity}}
{{Elements in biology}}
{{Pigmentation disorders}}

[[Category:Disturbances of human pigmentation]]
[[Category:Silver]]
[[Category:Toxic effects of metals]]