Two sisters and their niece complained of slate blue–gray discoloration of the skin. This feature was more remarkable in the older sister, aged 50 years. The color change, which was first noticed 10 years ago, increased predominantly in sun-exposed areas and to a lesser degree on the entire skin surface and oral mucosa (Figure 1). Her sister and niece, ages 48 and 26 years, respectively, had similar but barely perceptible pigmentation. No notable medical history was reported by the patients. To improve the symptoms of a vasomotor rhinitis, they had been applying every day at bedtime for many years, as a “familial” practice, a topical vasoconstrictor containing silver albuminate in nose drops (Argotone; Merck SpA, Firenze, Italy). Argotone, 100 mL, contains 1% silver protein, 0.9% ephedrine hydrochloride, and 0.5% sodium chloride. General clinical examinations were noncontributory, and routine laboratory data were within normal ranges.
Bianchi L, Orlandi A, Di Stefani A, Ricci R, Chimenti S. “Familial” Generalized Argyria. Arch Dermatol. 2006;142(6):781-798. doi:10.1001/archderm.142.6.789