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Skin manifestations of poisoning
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Another characteristic feature of chronic arsenicosis is hyperkeratosis of palms and soles (Figures 49.4 and 49.5). Hyperkeratosis may be graded as mild where there are minute wart-like papules (<2 mm), moderate form with raised wart-like thickening (2–5 mm), and severe with large (>5 mm) discrete or confluent elevations and even fissuring. Arsenical keratosis is more marked in areas subjected to trauma and friction. Sometimes it may also be seen over the dorsum of extremities and trunk [5]. Apart from the classical keratotic papules, diffuse palmoplantar thickening and fissuring may sometimes be seen.
Malignant tumors
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Arsenical keratoses are mainly seen in regions with a high content of arsenic in the drinking water [India (West bengal), Bangladesh] or after professional exposure.9,10 This may be associated with arsenical melanosis. The therapeutic administration of arsenical compounds such as Fowler’s solution or Asiatic pills was declared obsolete many decades ago, although there are countries in which they are still used to treat psoriasis and lichen planus. With the advent of Ayurvedic medicine, a new source of chronic arsenicism has appeared.11 Patients with arsenical keratoses have a very high risk to develop various cutaneous as well as internal cancers. The diagnosis must therefore prompt a general check-up of the patient. Arsenical keratoses appear as small, hard keratotic papules that develop anywhere on the skin, but particularly on the palms and soles. They are said to exhibit a higher autofluorescence with ultraviolet light than the surrounding epidermis of the palms and soles.10 Around and under the nails, keratotic papules and plaques develop that may eventually degenerate to Bowen’s disease and/or SCC.12 Nail dystrophy is an unspecific sign. Actinic keratosis, Bowen’s disease, SCC, and basal cell carcinoma (BCC) are the most important differential diagnoses.
Epithelial and fibroepithelial tumors
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Arsenical keratoses are now mainly seen in regions with a high content of arsenic in the drinking water168 or after professional exposure.169 This may be associated with arsenical melanosis.170 The use of arsenical insecticides in the wine-growing industry was forbidden in Europe in the late 1920s/early 1930s and the therapeutic administration of arsenical compounds such as Fowler's solution or Asiatic pills, was declared obsolete many decades ago although there are still countries in which they are used to treat psoriasis and lichen planus. With the advent of Ayurvedic medicine, a new source of chronic arsenicism has appeared.171 Patients with arsenical keratoses have a very high risk of developing internal cancers in various organs. The diagnosis must therefore prompt a general checkup of the patient. Clinically, arsenical keratoses appear as small hard keratotic papules that develop anywhere on the skin, but particularly on the palms and soles. They are said to exhibit a higher autofluorescence with ultraviolet light than the surrounding epidermis of the palms and soles. Around and under the nails, keratotic papules and plaques develop that may eventually degenerate to Bowen's disease and/or squamous cell carcinoma.172 It is not yet clear whether superficial basal cell carcinoma is more frequently arsenic-induced than Bowen's disease.173 Nail dystrophy is an unspecific sign.
Punctate porokeratosis—pruritic and hyperkeratotic papules on the palms and feet
Published in Baylor University Medical Center Proceedings, 2020
Patrick Michael Jedlowski, Gina Rainwater, So Yeon Paek
Other clinical entities may mimic PP, including keratosis puncta of the palmar creases, arsenical keratosis, and nevus comedonicus. Keratosis puncta of the palmar creases is a benign condition and variant of punctate keratoderma that occurs most commonly in African American patients. It is typified by hyperkeratotic pits limited to the palmar creases, as opposed to the diffuse palmoplantar lesions in our patient. Arsenical keratosis occurs due to chronic ingestion of arsenic most commonly via contaminated well water and presents with pigmentary changes of truncal skin and mucous membranes, palmoplantar keratosis, and Mee’s lines of the nails.9 Arsenical palmoplantar keratoses range in clinical appearance from indurated, gritty millimeter palmoplantar papules to yellow, verrucous papules and plaques.9 On histology, arsenical keratosis is characterized by compact hyperkeratosis and a thickened stratum granulosum but lacks the columns of parakeratosis seen in our case.9 Nevus comedonicus is a hamartomatous growth of the pilosebaceous unit distinguished by dilated follicles with pigmented, keratinaceous plugs and histopathology displaying epidermal invagination, hyperkeratosis and follicular plugging, which is not seen in this case.
Evaluation of the quality of life in patients with arsenic keratosis
Published in Cutaneous and Ocular Toxicology, 2018
Nazli Dizen Namdar, Inci Arikan, Cuneyt Kahraman, Emek Kocaturk, Merve Dagci, Ezgi Ece
Histologic characteristics of keratotic papulo-nodules are not generally contributory (mainly hyperkeratosis and acanthosis) as a diagnostic marker of arsenicosis, but early detection of few dysplastic cells can point towards early premalignant change10. In our study, we could not perform histopathological examination due to logistic inadequacy (the study was performed in a rural area where access to laboratory settings was very limited), but typical clues for arsenical keratosis such as late onset of symptoms, lack of family history, past environmental history of patients (consuming water with higher content of arsenic for years) and location of the lesions as well as the above described clinical characteristics were sufficient to make the diagnosis and rule out diseases which might mimic arsenical keratosis.