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Drug-induced hyperpigmention
Published in Dimitris Rigopoulos, Alexander C. Katoulis, Hyperpigmentation, 2017
Gold: Blue-gray hyperpigmentation of sun-exposed skin (chrysiasis) in 5%–25% of all treated patients. The process is dose dependent. Gold may produce purplish gingival discoloration. In the case of high-dose therapy, pigmentation may occur in a short time; in contrast, in the case of low-dose therapy, it occurs after months. Pigmentation persists long after the drug is discontinued. Pigmentation is frequently more pronounced around the eyes. Its source is organic colloidal gold preparations used in therapy for rheumatoid arthritis; there have also been some dermatological indications, such as pemphigus vulgaris.
Nail changes in systemic diseases and drug reactions
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
All causes of slate gray to azure diffuse nail or lunula discoloration have to be ruled out. Melanin is not a cause of such a pigmentation although when located deep subcutaneously it may provoke a more gray to bluish gray color as is seen in blue nevi; however, this is never as diffuse as in systemic argyrosis. In Wilson's disease, the copper may cause a similar azure color of the lunulae.249267–269 Gold therapy may lead to yellow to dark brown nail pigmentation, called chrysiasis.270–272 Mercury can also cause nail pigmentation.273,274 In ochronosis, the homogentisinic acid causes a diffuse yellow-brown to ochre imbibition of the collagen bundles that are homogenized and appear swollen and broken. The granular nature of the ochronotic pigment is not evident at first glance. These granules are free in the dermal connective tissue and in endothelial cells of blood vessels.275 Diffuse nail staining may also be seen due to antimalarials such as atabrine,276 mepacrine,277 amodiaquine,278 quinacrine,279 or chloroquine.280 It is worth noting that silver nitrate application on the nail, for example, in the treatment of granulation tissue due to ingrown nails, is completely different from systemic argyrosis (see Chapter 7).
Principles of Clinical Diagnosis
Published in Susan Bayliss Mallory, Alanna Bree, Peggy Chern, Illustrated Manual of Pediatric Dermatology, 2005
Susan Bayliss Mallory, Alanna Bree, Peggy Chern
Gold Reactions occur in about one-third to one-half of patientsClinical manifestations:Lichenoid reactionsPapulosquamous reactions (resembling pityriasis rosea)Exfoliative dermatitisMorbilliform eruptionsErythema nodosumChrysiasis can occur after prolonged use, resulting from deposition of gold salts in the skin, causing blue pigmentation of the skin and ocular conjunctiva
Distribution, metabolism, excretion, and toxicity of implanted silver: a review
Published in Drug and Chemical Toxicology, 2022
Niels Hadrup, Anoop K. Sharma, Nicklas R. Jacobsen, Katrin Loeschner
Argyria—the blue-gray discoloration of skin after substantial exposure levels of silver—is a consequence of deposition of silver granules. Localized argyria with granules containing silver, selenium and sulfur was seen in a 41-year-old woman, who 20 years previously had about 300 gold-coloured silver acupuncture needles permanently implanted (estimated dose: 1.4 g Ag = ∼20 mg Ag/kg bw). She also had deposits of pure gold intracellularly, and this so-called chrysiasis could have contributed to the abnormal pigmentation of her skin (Suzuki et al.1993). Localized argyria was reported after implantation of prostheses with 20 µm silver coating (estimated dose: 2 g/patient = ∼28 mg/kg bw). Argyria was proposed in seven of 32 patients who had prostheses implanted into their bones. These seven patients had a median time since the implantation of 26 months. Notably, no attempt was made to prove silver in the observed granules. The blood and tissue levels in patients with suspected argyria were not different from those with no argyria, 14 vs. 21 µg Ag/kg blood and 550 vs. 490 µg/kg tissue, respectively (Glehr et al.2013). The observed levels of silver in blood were lower after implantation than those observed after oral or dermal/mucosal exposures in humans (Hadrup and Lam 2014, Hadrup et al.2018), perhaps explaining why no cases of generalized argyria (covering other areas than those of exposure) have been reported after implantation.
Minocycline-induced hyperpigmentation: rapid resolution after 755nm alexandrite picosecond laser treatment
Published in Journal of Cosmetic and Laser Therapy, 2020
Jason K. Rivers, Misha Zarbafian, Brianne Vestvik, Sara Kawamura, Marcie Ulmer, L. Alexandra Kuritzky
Novel uses for picosecond lasers will continue to be identified as additional cases are reported. This type of laser has proved effective in the management of other pigments such as exogenous ochronosis and argyria (16,17). Q-switched lasers (694 nm Ruby, 755 nm alexandrite, and 1064 nm Nd:Yag) have caused laser-induced chrysiasis, a rare and potentially permanent cause of blue-gray pigmentation, in those who are receiving or have previously received systemic treatment with gold salts (15,18). Although unreported to date, it would seem prudent to avoid the use of picosecond lasers in similar patients to avoid the induction of chrysiasis.