Hi – Ho Silver

By Peter Galvin, MD

The man in the photo was admitted to the Prince of Wales Hospital in Hong Kong for an acute kidney injury related to his history of benign prostatic hypertrophy (BPH), or an enlarged prostate. He claimed the only medication he took was finasteride, used to treat his BPH. He was 84 years old and had worked for many years as a waiter. He was noted to have gray skin, as can be seen in panel A, and grey-blue fingernails, as seen in panel B. He said his skin had been that color for at least five years. His sclera, or the whites of his eyes, were also bluish grey. A serum silver level was 423 nmol per liter (reference value, <10). He denied any exposure to silver and denied taking any medication other than finasteride. A diagnosis of generalized agyria was made.

Generalized agyria, or agyriosis, is caused by exposure to silver compounds which leads to irreversible darkening of the skin. Skin color changes are most prominent in areas exposed to sunlight because sunlight catalyzes the reduction of elemental silver. Despite the startling color of the skin, agyria does not pose any serious health consequences. No one else in this patient’s family of building had any exposure to silver, and the source of silver in this case was not identified.

Years ago, before the advent of antibiotics, agyria was more common as colloidal silver, a liquid suspension of silver, was thought to have antimicrobial properties. It is still rarely used in alternative medicine. Not too long ago, Stan Jones, who was a Libertarian Senate candidate in 2002 and again in 2006 (he lost both), had blue-grey skin caused by agyria. He had taken colloidal silver in the late twentieth century because he believed that Y2K would cause antibiotics to become unavailable. If you are old enough to remember the lead-up to Y2K, all kinds of bad things were forecast to occur from Y2K, including planes falling out of the sky. Thankfully, none of those fears were realized.

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