Localized argyria from silver nasal piercing unresponsive to Q‐switched laser successfully treated with a 1064 picoseconds laser

Abstract

A 23-year-old woman with a 1-year history of a grayish silvery macule on the right nasal ala, following a silver jewelry nose piercing, presented to the laser clinic for consideration of, at her request, ablative laser treatment for removal of what she described as a discoloration that is having a profound effect on her psychological well-being. The macule was asymptomatic and had been unsuccessfully treated prior to her presentation with a 1064 nm Q-switched laser though the exact parameters were not available as this was performed in a different city. Treatment was performed with the 1064 nm wavelength of a picoseconds laser (Picoway; Candela) using the nonfractional zoom handpiece with a 4 mm spot, with 1.8 J/cm 2 in 2 passes. There was erythema as an endpoint. The macule gradually disappeared in <2 weeks with no scarring (Figure 1).Localized argyria is a gray-silvery colored macule or a patch that results from cutaneous contact to objects containing silver metal. 1 It is usually asymptomatic and in dermatology is seen mostly following piercings. It has also been seen following silver nitrate applications and acupuncture. 2 Previous reports have shown efficacy of Q-switched 1064 nm Nd:YAG laser in localized argyria; however, this was unsuccessful in our patient. 3 Treatment with a picoseconds laser was successful in one setting with no recurrence after 12 months.The picoseconds lasers generate ultrashort pulses in a trillionth of a second leading to a predominance of a photoacoustic effect rather than a photothermal one. While the efficacy of picoseconds lasers in tattoos is beyond doubt, superiority in the treatment of benign pigmented conditions compared to Q-switched nanosecond lasers was reported in split-face studies. 4,5 Reports of conditions unresponsive to the Q-switched nanosecond lasers, which subsequently cleared with the picoseconds laser-as is the case in our patient-further proves the superior efficacy of the picoseconds lasers. 6

Clinical and Forensic Aspects of the Different Subtypes of Argyria

“…For this reason, technicians have resorted to varied anesthesia techniques, with general anesthesia being offered in some cases [ 51 , 142 ]. Beyond that and a transient inflammation of the skin with edema, erythema, and scaling [ 74 , 88 ], no other significant adverse effects or sequelae have been reported, with adequate healing of the treated areas [ 51 , 142 , 216 , 219 , 223 , 252 , 281 , 282 ].…”

“…Discoloration of the leg over a silver-coated megaprosthesis used for distal femoral osteosarcoma ( E ). Reprinted from ( A )—[ 88 ], ( B )—[ 89 ], ( C )—[ 87 ], ( D )—[ 73 ] and ( E )—[ 90 ].…”

“…Discoloration of the leg over a silver-coated megaprosthesis used for distal femoral osteosarcoma (E). Reprinted from (A)- [88], (B)- [89], (C)- [87], (D)- [73] and (E)- [90]. Amalgam tattoo (Figure 4) is probably the most common form of LA [91][92][93].…”

Effective laser treatment options for argyria: Review of literatures

“…It presents with strikingly generalized, gray discoloration of skin or mucosa, caused by the accumulation and deposition of the silver in tissues 1 . Localized argyria induced by piercing also has been reported 2,3 . As skin discoloration negatively affect the quality of life in individuals affected by argyria, various kinds of laser devices such as 1064 nm Nd:Yag laser 1,2,4 and 755 nm alexandrite laser 3‐6 have been used to effectively clear the discoloration in argyria.…”

“…Localized argyria induced by piercing also has been reported 2,3 . As skin discoloration negatively affect the quality of life in individuals affected by argyria, various kinds of laser devices such as 1064 nm Nd:Yag laser 1,2,4 and 755 nm alexandrite laser 3‐6 have been used to effectively clear the discoloration in argyria. Herein, we reviewed and summarized available laser treatments for argyria from published literatures, including laser devices used for argyria, their parameters, and their responses.…”