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Argyria - Nail and Distal Digit
See also in: Overview,External and Internal Eye
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Argyria - Nail and Distal Digit

See also in: Overview,External and Internal Eye
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Contributors: Shari Lipner MD, PhD, Bertrand Richert MD, Robert Baran MD
Other Resources UpToDate PubMed

Synopsis

Argyria results from chronic exposure to silver, which deposits in the skin, nails, mucous membranes, and internal organs. It is characterized by a diffuse bluish-gray discoloration favoring sun-exposed skin, as well as the nails. Systemic effects include hepatitis, nephritis, retinal toxicity, and neurotoxicity.

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

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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
The differential for systemic disease includes the following:

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.

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References

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Last Reviewed: 05/14/2018
Last Updated: 05/14/2018
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Argyria - Nail and Distal Digit
See also in: Overview,External and Internal Eye
Print 5 Images
View all Images (5)
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Argyria : Diffuse blue nails, Sclera/bulbar conjunctiva color change, Silver compound exposure, Photodistributed
Clinical image of Argyria
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