Argyria results from chronic exposure to silver, which deposits in the skin, nails, mucous membranes, and internal organs. Depending on the method of exposure, pigment changes can present in a generalized or local fashion.

Generalized argyria is characterized by a diffuse bluish-gray discoloration that favors sun-exposed skin, as well as the nails. Systemic effects include hepatitis, nephritis, retinal toxicity, and neurotoxicity.

After sufficient systemic silver exposure (usually more than 4-5 g), silver accumulates in tissues and forms a silver-protein compound. When exposed to light, photoreduction occurs, forming metallic silver. Oxidation causes formation of silver selenide and silver sulfide, which have low solubility, and explains why the pigment tends to be permanent in the absence of treatment. Furthermore, these compounds stimulate melanin production.

Localized argyria results from chronic topical exposure to silver. Argyria involving the eye may be referred to as ocular argyrosis. Localized ocular argyrosis may result from the use of silver-containing eye drops (eg, Argyrol) or cosmetics. The cornea may also be involved.

Other common sources of silver in patients with argyria include silver-containing alternative therapies (acupuncture, colloidal silver preparations, and other tablets, liquids, and creams), silver dressings, occupational exposure (eg, jewelers, silversmiths), dental procedures, and wearing silver jewelry / piercings. Rare cases of localized argyria following implantation of silver-coated medical devices have been reported.