Argyria - Nail and Distal Digit
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Synopsis
After sufficient silver exposure, it accumulates in tissues and forms a silver-protein compound. After exposure to light, photoreduction occurs, forming metallic silver. Oxidation causes formation of silver selenide and silver sulfide, which have low solubility, and explains why the pigment tends to be permanent. Furthermore, these compounds stimulate melanin production. Common sources of silver in patients with argyria include silver-containing medications (tablets, liquids, creams) from alternative medicines and occupational exposure.
Codes
ICD10CM:L81.8 – Other specified disorders of pigmentation
SNOMEDCT:
255636009 – Argyria
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
The differential for drug-induced nail pigmentation includes the following:- Antimalarials – blue-black discoloration of the nail bed, underlining the distal border of the lunulae
- Minocycline (rare) – blue-gray, slate-gray discoloration of the proximal nail bed, sometimes with involvement of the proximal nail fold
- Zidovudine – faint blue pigmentation of the lunulae or melanonychia
- Phenothiazine – slate-blue to blue-black pigmentation of the nail bed secondary to high cumulative doses of the drug
- Phenolphthalein – bluish discoloration of the lunulae
- Aniline poisoning – purple-blue discoloration of the nail bed due to cyanosis
- Wilson disease – azure lunula
- Alkaptonuria – bluish-gray, bluish-black, or brown fingernail beds
- Cyanosis
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:05/13/2018
Last Updated:05/13/2018
Last Updated:05/13/2018
Argyria - Nail and Distal Digit
See also in: Overview,External and Internal Eye