• DOI:10.1097/01.ASW.0000276415.91750.0f
• Corpus ID: 31383370

So What If You Are Blue? Oral Colloidal Silver and Argyria Are Out: Safe Dressings Are In

@article{Okan2007SoWI,
  title={So What If You Are Blue? Oral Colloidal Silver and Argyria Are Out: Safe Dressings Are In},
  author={Denis Okan and Kevin Woo and R Gary Sibbald},
  journal={Advances in Skin \& Wound Care},
  year={2007},
  volume={20},
  pages={326-330}
}

• Denis Okan, K. Woo, R. Sibbald
• Published 1 June 2007
• Medicine
• Advances in Skin & Wound Care

For centuries, humans have been exposed to silver-containing compounds by means of the natural environment, water vessels, industry, and medicines. Long-term ingestion or excessive application of silver preparations can lead to generalized argyriaVa blue-gray discoloration of the skin, eyes, and internal organs, resulting from silver salt deposits in the tissues. Recently, the popularity of natural medicines and the volume of health advice on the Internet have increased. Some health food and nutraceutical manufacturers are promoting ineffective colloidal silver-based products as treatments for major illnesses and for their unsubstantiated immune-stimulating, antimicrobial, and anti-inflammatory effects (Table 1). Colloidal silver suspensions are solutions of submicroscopic metallic silver particles suspended in a colloid base. These products deliver predominantly inactive metallic silver, not the antimicrobial ionized form. In contrast, safe ionized silver dressings that combine effective antimicrobial properties with moisture balance and autolytic debridement are used in wound care. These dressings occasionally cause skin surface keratin staining, but the silver levels are too low to cause even local dermal argyria. Ionized silver is safe when used in appropriate moisture-balance dressings and releases about 1000 times less silver compared to silver sulfadiazine cream or colloidal silver products. Silver sulfadiazine cream (a silver derivative of sulfonamide), known as Flamazine (Smith & Nephew, Hull, UK) and Silvadene (Monarch Pharmaceuticals, Inc, Bristol, TN), is a commonly used topical agent for burn therapy. This cream also has a high level of silver release with relatively low levels of ionized silver. Use of silver sulfadiazine cream leaves a residual potentially proinflammatory film from the components of the cream vehicle. Increases in serum and urinary silver levels and argyria have been documented with long-term silver sulfadiazine use. Dressings impregnated with ionic silver are applied to wounds for their antimicrobial and moisture balance properties. Dressings with a relatively high, moderate, and low release level of ionized silver are frequently used in acute and chronic wound care. Lansdown et al identifies 3 distinct forms of silver dressings: (1) those that allow silver ion exchange between the dressing and the wound for bactericidal action, such as Acticoat (Smith & Nephew, Hull, UK); (2) dressings that absorb and lock exudate, deactivating harmful constituents inside the dressing, with a low release of silver into the wound bed (eg, Aquacel Ag, ConvaTec, Skillman, NJ) or with no released silver but a local antimicrobial action in the dressing (eg, Actisorb Silver, Johnson & Johnson Wound Management, a division of ETHICON, Inc, Somerville, NJ); and (3) those that release silver sulfadiazine into the wound bed, such as the European-marketed Urgotul Ag, (Urgo, Dijon, France). Some dressings, such as Contreet Foam (Coloplast, Humlebaek, Denmark), work by allowing both a partial fluid lock and a free ion and fluid exchange between the wound bed and the dressing so antimicrobial action occurs both inside the dressing core and on the wound surface through a moderate amount of silver release (Table 2). These dressing products release a relatively low silver load (a high-release silver dressing releases a relatively low amount of silver compared to silver sulfadiazine cream) and, when used properly, these dressings are not associated with the signs and symptoms of local or generalized argyria, although mild, temporary keratin staining may result. Argyria is associated with a high level of metallic silver at the application site locally absorbed in the dermis or systemically delivered to the skin at many sites. The antimicrobial effect is associated with ionized silver levels locally. A recent partial-thickness burn study by Trop et al reported elevated liver enzymes and an argyria-like discoloration of a patient with 30% total body surface area burns after 7 days of treatment with the Acticoat dressing. The relatively sudden onset of discoloration suggests an abnormal metabolic response. Silver ingested orally or absorbed by mucous membranes is bound to the plasma protein