Exposure to a number of heavy metals may cause pigmentation of the skin and mucous membranes. The cause can often be determined based on clinical, laboratory and skin biopsy findings.
Heavy metals that may pigment the skin:
(1) arsenic
(2) bismuth
(3) gold salts (chrysoderma, chrysiasis)
(4) lead
(5) mercury
(6) silver (argyria)
The examination should include evaluation of:
(1) conjunctiva and sclera
(2) oral mucosa and gingiva
(3) sun-exposed areas of skin
|
Heavy Metal |
Skin Color Change |
Associations |
|
arsenic |
bronze, especially on trunk; areas of hypopig-mentation may be present |
poisoning, occupational, proprietary medicines, environmental |
|
bismuth |
blue-gray |
Pepto-Bismol, other medications for GI complaints |
|
gold salts |
blue to slate-gray, especially in sun-exposed skin |
therapy of rheumatoid arthritis or other autoimmune disease |
|
lead |
|
occupational, environmental |
|
mercury |
brown |
occupational, environmental, proprietary medicines |
|
silver |
blue to slate-gray |
occupational, dietary, proprietary medicines |
|
Heavy Metal |
Changes Seen in the Skin Biopsy |
|
arsenic |
melanin is increased |
|
bismuth |
small granules are seen in the papillary and reticular dermis; may be present within the basement membranes of sweat glands |
|
gold salts |
black, round to oval, variably sized granules in dermal histiocytes and around blood vessels |
|
lead |
|
|
mercury |
brown to black granules in upper dermis around capillaries and associated with elastic fibers or collagen; granules may be within dermal histiocytes; melanin may be increased |
|
silver |
small, uniform, refractile granules in the dermis, especially around sweat glands and in the intima of blood vessels; melanin may be increased; may be confused with a blue nevus |
Specialty: Dermatology, Surgery, general
