Referring to the scale of clinician erythema assessment (CEA) and photonumeric guide for Caucasian patients with erythematotelangiectatic rosacea, two board certified dermatologists independently assessed the severity of erythema in 48 Japanese patients with the same disease under controlled temperature and humidity conditions or general room conditions. As a result, the evaluations between different conditions and among observers were considered equivalent and demonstrating that the evaluations of erythema severity in Japanese rosacea patients can be assessed with reference to the CEA in a general clinical examination room condition. However, when using the CEA and the photonumeric guide for Caucasian patients, no cases corresponding to the most severe grade (CEA 4) were observed among Japanese cases, and severe cases (CEA 3) were also few. Therefore, for accurate evaluations, it was considered necessary to have more appropriate Japanese translation of the CEA definition and a photonumeric guide composed of Japanese patients.

We report herein a case of generalized argyria following the ingestion of silver ionized water. A 64-year-old woman presented with skin discoloration that she had noticed for the past two years. Physical examination revealed a diffuse bluish-gray discoloration of her skin, particularly in sun-exposed areas. Histological examination showed deposition of numerous dark brown particles around the basement membranes of the sweat glands. Based on the clinicopathological features, generalized argyria was strongly suspected. Detailed history taking revealed that the health beverage she had been consuming for three years contained ionized silver. In our review of 60 reported cases of generalized argyria, ingestion of preparations containing ionized silver tended to result in a shorter time to onset compared with other silver-containing preparations. In recent years, ionized silver and colloidal silver products have sometimes been used as dietary supplements or in alternative medicine, and caution is therefore warranted.