March 2016






History: A 69 yo woman presented with a 5 year history of an itchy rash on the lower legs. She had been taking an over the counter silver supplement she purchased online for approximately two years with some improvement in the rash. However, she developed blue-grey discoloration of the face that persisted despite stopping the silver supplement over three years ago. She denied using other possible offending medications such as amiodarone or minocycline.


Past Medical History: Hypertension, hyperlipidemia, chronic pain and headache.


Social History: No illicit drugs. No tobacco, minimal alcohol.


Family History: No history of pigmentary disorders.


Medications: Losartan, Ibuprofen, iron, tramadol


Allergies: Codeine-containing products and shellfish


Physical Exam: Anxious, tearful WF with slate blue discoloration of the upper half of the face, most prominent over malar prominences and the forehead (Fig.1).On the lower extremities there were eczematous patches b/l involving the ankles and shins.

The digits and nails were within normal limits.


Laboratory Results: CBC with mild anemia, CMP WNL, Ferritin low.




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