Unknown: Bluish-gray macules on the hands of a healthy 34 year-old man

Abstract

A 34 year-old man presented with asymptomatic bluish-gray macules on his hands that had developed over the previous 2 years. He was otherwise healthy and was on no regular medication. A detailed clinical history and histologic examination allowed the diagnosis.Histopathologic examination showed deposits of aggregated granules of black pigment in the dermis, localized preferentially around the sweat glands. This was consistent with the deposition of silver salts. Given the absence of systemic complaints or other signs and symptoms, a conservative approach was adopted. The lesions remain unchanged after one year of follow up.The wide range of uses for silver allows exposure to its compounds (metal, soluble and insoluble compounds) through different routes of entry, namely direct contact, ingestion, inhalation, and puncture. [1] This exposure is usually occupational, iatrogenic, or accidental. [1] Argyria is an exceedingly rare disease that became uncommon because medications containing silver are no longer used and occupational protection has evolved significantly. [2] It is caused by the deposition of silver grains in the skin and is further divided into localized and generalized forms, according to the route of entry. [1-4] Localized argyria is caused by direct contact with silver (the tiny particles penetrate the skin through the sweat glands) or puncture. [1, 3, 4] These deposits remain indefinitely in the skin and are characterized by a bluish gray color, more prominent in the photo-exposed areas. [3, 4] In the localized forms, patients usually don't have systemic symptoms and the problem is cosmetic. [1-4] Given the improvement in the safety of working conditions, occupational argyria cases are becoming quite uncommon. [1-4].