Reasonable Rascal
11-04-01, 17:30
I do not regard colloidal silver taken internally of being of any medical benefit. There is no scientific evidence that silver is anything more than a topical germicidal. Silver is still a heavy metal and poses the same problems as any other.
I am a firm believer in "proven" alternative medicine, please make no mistake. I have personally used herbals, am presently using an electrom-magnetic bone growth stimulation unit, and believe in the efficacy of other "alternative" medical treatments as appropriate.
However, that said, colloidal silver in my best judgement is not only a dead end medicinal but dangerous in the long run.
RR
---------------------------------------------
Authored by Kamila K Padlewska, MD, rectumistant Professor, Department of Dermatology and Venereology, Warsaw Medical School, Poland
Coauthored by Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey
Edited by Smeena Sabir, MD, Staff Physician, Department of Dermatology, University of Pennsylvania; Richard Vinson, MD, Chief, Department of Dermatology, William Beaumont Medical Center; Jeff Miller, MD, rectumistant Professor, Department of Dermatology, Penn State University Milton S Hershey Medical Center; Joel M Gelfand, MD, Staff Physician, Department of Dermatology, University of Pennsylvania Hospital; and William D James, MD, Chair of the Sulzberger Institute; Fellowship Director, Vice-Chair, Albert M Kligman Professor, Department of Dermatology, University of Pennsylvania School of Medicine
eMedicine Journal, June 20 2001, Volume 2, Number 6
INTRODUCTION
Background: Argyria results from prolonged contact to or ingestion of silver salts. It produces a gray to gray-black staining of skin and mucous membranes produced by silver deposition. Silver may be deposited in the skin either from industrial exposure or as a result of medications containing silver salts. The most common cause of argyria is mechanical impregnation of the skin by small silver particles in workers involved in silver mining, silver refining, silverware and metal alloy manufacturing, metallic films on glass and china, electroplating solutions, and photographic processing. Colloidal silver dietary supplements are marketed widely for cancer, AIDS, diabetes mellitus, and herpetic infections. Cases have followed the prolonged use of silver salts for the irrigation of urethral or nasal mucous membranes, in eye drops, wound dressing, and the excessive use of an oral smoking remedy containing silver acetate. It also has been attributed to surgical and dental procedures (eg, silver amalgam-tattooing, silver sutures used in abdominal surgery). Blue macules have appeared at sites of acupuncture needles and silver earring sites. Great individual variability exists in the length of exposure and total dose needed to result in argyria.
Pathophysiology:
Localized argyria: This occurs in the conjunctiva or oral mucous membrane after long-term topical treatment with silver salt solutions or short-contact acupuncture.
Universal argyria: This can develop after long-term systemic treatment with silver salts containing drugs. This used to occur in patients who had taken silver protein suspension for chronic gastritis or gastric ulcer, or as nose drops. Argyria also happens as an occupational disease in workers who prepare artificial pearls or who are employed in the cutting and polishing of silver (absorption of silver dust).
The normal human body contains about 1 mg silver; the smallest amount of silver reported to produce generalized argyria in humans ranges from 4-5 g to 20-40 g. Silver at 50-500 mg/kg body weight is the lethal toxic dose in humans.
Frequency:
In the US: Argyria has become a rare dermatosis, mainly due to the avoidance of silver-containing compounds as medicinals and a decrease in occupational exposure in the silver industry. Exposure to silver was common in the early part of this century. The famous "Blue Man," who was exploited in the
Barnum and Bailey Circus sideshow, had a classic case of argyria.
CLINICAL
History: A careful history is necessary. Be sure to inquire about possible occupational and environmental exposure, the use of dietary supplements in general, and colloidal silver protein dietary supplements in
particular.
Physical:
Early on, a gray-brown staining of the gums develops, later progressing to involve the skin diffusely. The cutaneous pigmentation usually is a slate-gray, metallic, or blue-gray color and may be clinically apparent after a few months, but usually takes many years and depends on the degree of exposure.
The hyperpigmentation is most apparent in the sun-exposed areas of skin, especially the forehead, nose, and hands.
In some patients, the entire skin acquires a slate blue-gray color.
The sclerae, nail beds, and mucous membranes may become hyperpigmented.
Viscera tend to show a blue discoloration, including the spleen, liver, and gut, findings evident during abdominal surgery or at postmortem examination.
Causes: Though pigmentary changes occur primarily in sun-exposed sites, granules are evenly deposited throughout all skin. Differing theories exist as to why the blue-gray pigmentation is restricted to sun-exposed sites. Some believe that silver compounds complexed with proteins in the skin are reduced to elemental silver by light, similar to the process of photo imaging. Others contend that silver plus light stimulates melanogenesis, which results in the blue-gray color.
DIFFERENTIALS
Ochronosis
Other Problems to be Considered:
Medications (ie, phenothiazines, antimalarials, amiodarone, minocycline)
Hemochromatosis
Polycythemia vera
Addison disease
Diffuse melanosis in metastatic melanoma
Heavy metals (ie, mercury, bismuth, arsenic, gold, lead)
Central cyanosis (impaired pulmonary function, anatomic shunt, hemoglobin abnormalities,
methemoglobinemia)
Peripheral cyanosis (reduced cardiac output)
WORKUP
Procedures:
The diagnosis of argyria is established by skin biopsy with formaldehyde fixed, paraffin embedded sections stained with hematoxylin-eosin
Histologic Findings: Small, round, brown-black granules appear singly or in clusters, and are evident on routine stains. They spare both the epidermis and its appendages, appearing in greatest numbers in the basement membrane zone surrounding sweat glands. These silver granules also favor the connective tissue sheaths around pilosebaceous structures and nerves. They have a predilection for elastic fibers and are best visualized as strikingly refractile with dark-field illumination. An increase in the amount of melanin in exposed skin also appears to occur. Electron microscopy demonstrates electron-dense granules. In early cases, they are located within fibroblasts and macrophages, while later most are present extracellularly. Neutron-activation analysis, atomic absorption spectrophotometry, or x-ray dispersive microanalysis can be used to confirm that the granules contain silver, and often also sulfur and less commonly selenium. A simpler option is to decolorize the silver by placing histologic sections into 1% potassium ferricyanide in 20% sodium thiosulfate.
TREATMENT
Medical Care:
Treatment with depigmentary preparations is not satisfactory; however, it has been reported that 5% hydroquinone treatment may reduce the number of silver granules in the upper dermis and around sweat glands, and diminish the number of melanocytes.
Chelation attempts to remove silver from the body have been unsuccessful.
Sunscreens and opaque cosmetics may be helpful in preventing further pigmentary darkening and aid in masking obvious discoloration.
MEDICATION
Selenium and sulfur have been shown to have favorable modifying effects on the metabolism and toxicity of silver by forming complexes with silver. Silver selenide is highly insoluble in vivo, and this effectively reduces the availability of monovalent silver to interfere with normal enzymatic activities in tissues. The silver-sulfur complexes formed in vivo, however, do not seem as stable as silver-selenium complexes.
Drug Category: Pigment agent - It has been reported that 4% hydroquinone treatment could reduce the number of silver granules in the upper dermis and around sweat glands and reduce the number of melanocytes; however, no completely satisfactory treatment modalities exist and some pigmentation remains permanently.
Drug Name
Hydroquinone (Eldopaque-Forte, Solaquin Forte, Lustra)- Topical application produces a reversible depigmentation of the skin by the inhibition of the enzymatic oxidation of tyrosine to 3,4-dihydroxyphenylalanine and suppression of melanocyte metabolic process.
Adult Dose
Apply to affected areas bid, in the morning and before bedtime
Pediatric Dose
<12 years: Not established
Contraindications
Documented hypersensitivity and sunburns
Interactions
None reported
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Avoid solar exposure; not for ophthalmic, nasal, or otic use; application area should not exceed that of face, neck, hands, or arms
FOLLOW-UP
Complications:
The systemic toxic effects of silver may include:
Gastrointestinal catarrh
Tissue wasting
Uremia
Albuminuria
Fatty degeneration of the liver, kidney, and heart
Hemorrhage
Idiopathic thrombocytopenia
Fluidity of the blood
Chronic bronchitis
Loss of coordination
Decreased night vision
Gustatory disturbance
Vestibular impairment
Seizure of the grand mal type
Death by paralysis of the respiratory system
Current thought holds that the substantial amounts of silver in argyria usually result in no serious effects on human health. There are, however, a few cases with notable clinical symptoms and signs. This lack of
significant systemic silver toxicity in argyria may be due to the interaction of selenium and sulfur with silver in vivo.
Prognosis:
A permanent and irreversible metallic tinge occurs in the skin of patients with argyria.
BIBLIOGRAPHY
Bouts BA: Images in clinical medicine. Argyria. N Engl J Med 1999 May 20; 340(20): 1554[Medline].
Fung MC, Bowen DL: Silver products for medical indications: risk-benefit rectumessment. J Toxicol Clin
Toxicol 1996; 34(1): 119-26[Medline].
Gulbranson SH, Hud JA Jr, Hansen RC: Argyria following the use of dietary supplements containing colloidal silver protein. Cutis 2000 Nov; 66(5): 373-4[Medline].
Johnston AM, Memon AA: A Medical Mystery. N Engl J Med 1999 Apr 1; 340(13): 1011.
Lee SM, Lee SH: Generalized argyria after habitual use of AgNO3. J Dermatol 1994 Jan; 21(1):50-3[Medline].
Legat FJ, Goessler W, Schlagenhaufen C: Argyria after short-contact acupuncture. Lancet 1998;352(9123): 241.
Prescott RJ, Wells S: Systemic argyria. J Clin Pathol 1994 Jun; 47(6): 556-7[Medline].
Sato S, Sueki H, Nishijima A: Two unusual cases of argyria: the application of an improved tissue processing method for X-ray microanalysis of selenium and sulphur in silver-laden granules.
Br J Dermatol 1999 Jan; 140(1): 158-63[Medline].
_________________
Knowledge shared is learning gained by both teacher and student.
I am a firm believer in "proven" alternative medicine, please make no mistake. I have personally used herbals, am presently using an electrom-magnetic bone growth stimulation unit, and believe in the efficacy of other "alternative" medical treatments as appropriate.
However, that said, colloidal silver in my best judgement is not only a dead end medicinal but dangerous in the long run.
RR
---------------------------------------------
Authored by Kamila K Padlewska, MD, rectumistant Professor, Department of Dermatology and Venereology, Warsaw Medical School, Poland
Coauthored by Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey
Edited by Smeena Sabir, MD, Staff Physician, Department of Dermatology, University of Pennsylvania; Richard Vinson, MD, Chief, Department of Dermatology, William Beaumont Medical Center; Jeff Miller, MD, rectumistant Professor, Department of Dermatology, Penn State University Milton S Hershey Medical Center; Joel M Gelfand, MD, Staff Physician, Department of Dermatology, University of Pennsylvania Hospital; and William D James, MD, Chair of the Sulzberger Institute; Fellowship Director, Vice-Chair, Albert M Kligman Professor, Department of Dermatology, University of Pennsylvania School of Medicine
eMedicine Journal, June 20 2001, Volume 2, Number 6
INTRODUCTION
Background: Argyria results from prolonged contact to or ingestion of silver salts. It produces a gray to gray-black staining of skin and mucous membranes produced by silver deposition. Silver may be deposited in the skin either from industrial exposure or as a result of medications containing silver salts. The most common cause of argyria is mechanical impregnation of the skin by small silver particles in workers involved in silver mining, silver refining, silverware and metal alloy manufacturing, metallic films on glass and china, electroplating solutions, and photographic processing. Colloidal silver dietary supplements are marketed widely for cancer, AIDS, diabetes mellitus, and herpetic infections. Cases have followed the prolonged use of silver salts for the irrigation of urethral or nasal mucous membranes, in eye drops, wound dressing, and the excessive use of an oral smoking remedy containing silver acetate. It also has been attributed to surgical and dental procedures (eg, silver amalgam-tattooing, silver sutures used in abdominal surgery). Blue macules have appeared at sites of acupuncture needles and silver earring sites. Great individual variability exists in the length of exposure and total dose needed to result in argyria.
Pathophysiology:
Localized argyria: This occurs in the conjunctiva or oral mucous membrane after long-term topical treatment with silver salt solutions or short-contact acupuncture.
Universal argyria: This can develop after long-term systemic treatment with silver salts containing drugs. This used to occur in patients who had taken silver protein suspension for chronic gastritis or gastric ulcer, or as nose drops. Argyria also happens as an occupational disease in workers who prepare artificial pearls or who are employed in the cutting and polishing of silver (absorption of silver dust).
The normal human body contains about 1 mg silver; the smallest amount of silver reported to produce generalized argyria in humans ranges from 4-5 g to 20-40 g. Silver at 50-500 mg/kg body weight is the lethal toxic dose in humans.
Frequency:
In the US: Argyria has become a rare dermatosis, mainly due to the avoidance of silver-containing compounds as medicinals and a decrease in occupational exposure in the silver industry. Exposure to silver was common in the early part of this century. The famous "Blue Man," who was exploited in the
Barnum and Bailey Circus sideshow, had a classic case of argyria.
CLINICAL
History: A careful history is necessary. Be sure to inquire about possible occupational and environmental exposure, the use of dietary supplements in general, and colloidal silver protein dietary supplements in
particular.
Physical:
Early on, a gray-brown staining of the gums develops, later progressing to involve the skin diffusely. The cutaneous pigmentation usually is a slate-gray, metallic, or blue-gray color and may be clinically apparent after a few months, but usually takes many years and depends on the degree of exposure.
The hyperpigmentation is most apparent in the sun-exposed areas of skin, especially the forehead, nose, and hands.
In some patients, the entire skin acquires a slate blue-gray color.
The sclerae, nail beds, and mucous membranes may become hyperpigmented.
Viscera tend to show a blue discoloration, including the spleen, liver, and gut, findings evident during abdominal surgery or at postmortem examination.
Causes: Though pigmentary changes occur primarily in sun-exposed sites, granules are evenly deposited throughout all skin. Differing theories exist as to why the blue-gray pigmentation is restricted to sun-exposed sites. Some believe that silver compounds complexed with proteins in the skin are reduced to elemental silver by light, similar to the process of photo imaging. Others contend that silver plus light stimulates melanogenesis, which results in the blue-gray color.
DIFFERENTIALS
Ochronosis
Other Problems to be Considered:
Medications (ie, phenothiazines, antimalarials, amiodarone, minocycline)
Hemochromatosis
Polycythemia vera
Addison disease
Diffuse melanosis in metastatic melanoma
Heavy metals (ie, mercury, bismuth, arsenic, gold, lead)
Central cyanosis (impaired pulmonary function, anatomic shunt, hemoglobin abnormalities,
methemoglobinemia)
Peripheral cyanosis (reduced cardiac output)
WORKUP
Procedures:
The diagnosis of argyria is established by skin biopsy with formaldehyde fixed, paraffin embedded sections stained with hematoxylin-eosin
Histologic Findings: Small, round, brown-black granules appear singly or in clusters, and are evident on routine stains. They spare both the epidermis and its appendages, appearing in greatest numbers in the basement membrane zone surrounding sweat glands. These silver granules also favor the connective tissue sheaths around pilosebaceous structures and nerves. They have a predilection for elastic fibers and are best visualized as strikingly refractile with dark-field illumination. An increase in the amount of melanin in exposed skin also appears to occur. Electron microscopy demonstrates electron-dense granules. In early cases, they are located within fibroblasts and macrophages, while later most are present extracellularly. Neutron-activation analysis, atomic absorption spectrophotometry, or x-ray dispersive microanalysis can be used to confirm that the granules contain silver, and often also sulfur and less commonly selenium. A simpler option is to decolorize the silver by placing histologic sections into 1% potassium ferricyanide in 20% sodium thiosulfate.
TREATMENT
Medical Care:
Treatment with depigmentary preparations is not satisfactory; however, it has been reported that 5% hydroquinone treatment may reduce the number of silver granules in the upper dermis and around sweat glands, and diminish the number of melanocytes.
Chelation attempts to remove silver from the body have been unsuccessful.
Sunscreens and opaque cosmetics may be helpful in preventing further pigmentary darkening and aid in masking obvious discoloration.
MEDICATION
Selenium and sulfur have been shown to have favorable modifying effects on the metabolism and toxicity of silver by forming complexes with silver. Silver selenide is highly insoluble in vivo, and this effectively reduces the availability of monovalent silver to interfere with normal enzymatic activities in tissues. The silver-sulfur complexes formed in vivo, however, do not seem as stable as silver-selenium complexes.
Drug Category: Pigment agent - It has been reported that 4% hydroquinone treatment could reduce the number of silver granules in the upper dermis and around sweat glands and reduce the number of melanocytes; however, no completely satisfactory treatment modalities exist and some pigmentation remains permanently.
Drug Name
Hydroquinone (Eldopaque-Forte, Solaquin Forte, Lustra)- Topical application produces a reversible depigmentation of the skin by the inhibition of the enzymatic oxidation of tyrosine to 3,4-dihydroxyphenylalanine and suppression of melanocyte metabolic process.
Adult Dose
Apply to affected areas bid, in the morning and before bedtime
Pediatric Dose
<12 years: Not established
Contraindications
Documented hypersensitivity and sunburns
Interactions
None reported
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Avoid solar exposure; not for ophthalmic, nasal, or otic use; application area should not exceed that of face, neck, hands, or arms
FOLLOW-UP
Complications:
The systemic toxic effects of silver may include:
Gastrointestinal catarrh
Tissue wasting
Uremia
Albuminuria
Fatty degeneration of the liver, kidney, and heart
Hemorrhage
Idiopathic thrombocytopenia
Fluidity of the blood
Chronic bronchitis
Loss of coordination
Decreased night vision
Gustatory disturbance
Vestibular impairment
Seizure of the grand mal type
Death by paralysis of the respiratory system
Current thought holds that the substantial amounts of silver in argyria usually result in no serious effects on human health. There are, however, a few cases with notable clinical symptoms and signs. This lack of
significant systemic silver toxicity in argyria may be due to the interaction of selenium and sulfur with silver in vivo.
Prognosis:
A permanent and irreversible metallic tinge occurs in the skin of patients with argyria.
BIBLIOGRAPHY
Bouts BA: Images in clinical medicine. Argyria. N Engl J Med 1999 May 20; 340(20): 1554[Medline].
Fung MC, Bowen DL: Silver products for medical indications: risk-benefit rectumessment. J Toxicol Clin
Toxicol 1996; 34(1): 119-26[Medline].
Gulbranson SH, Hud JA Jr, Hansen RC: Argyria following the use of dietary supplements containing colloidal silver protein. Cutis 2000 Nov; 66(5): 373-4[Medline].
Johnston AM, Memon AA: A Medical Mystery. N Engl J Med 1999 Apr 1; 340(13): 1011.
Lee SM, Lee SH: Generalized argyria after habitual use of AgNO3. J Dermatol 1994 Jan; 21(1):50-3[Medline].
Legat FJ, Goessler W, Schlagenhaufen C: Argyria after short-contact acupuncture. Lancet 1998;352(9123): 241.
Prescott RJ, Wells S: Systemic argyria. J Clin Pathol 1994 Jun; 47(6): 556-7[Medline].
Sato S, Sueki H, Nishijima A: Two unusual cases of argyria: the application of an improved tissue processing method for X-ray microanalysis of selenium and sulphur in silver-laden granules.
Br J Dermatol 1999 Jan; 140(1): 158-63[Medline].
_________________
Knowledge shared is learning gained by both teacher and student.