ABSTRACT
The man with the findings shown here had used a very old silver-containing sinus preparation for years. What is the diagnosis?
a. Muehrcke’s nails b. Terry’s nails c. Yellow nail syndrome d. Green nail syndrome e. Argyria
• Findings include slate-gray or bluish discoloration of nails, skin, gingivae, sclerae, and some deep tissues as a result of long-term use of soluble silver salts
• Dark-field microscopic examination of sweat glands, hair follicles, and blood vessels shows refractile white granules
• Discoloration is not related to quantity of silver in skin
• Photoactivation reduces silver and results in more discoloration in areas exposed to sunlight
• Proprietary formulations for the nose, sinuses, and general cold remedies used to contain silver salts (now rare in the United States)
• More recently, retailers of health food supplements have promoted products containing colloidal silver protein for prevention of various ailments
• Discoloration is a result of prolonged use of silver-containing products (usually for more than 3 years)
• There is no effective treatment. Argyria is not reversible
• Differential diagnosis for blue nails includes the following:
Wilson’s disease Prolonged use of quinacrine or phenolphthalein Topical mercury Bacterial infection under the fingernail (such as Pseudomonas aeruginosa paronychia, but this is usually greener and rarely affects all the nails)
