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Arsenical Keratosis

Background

Arsenic is a natural occurring metalloid, an abundant element found in many types of rocks. Weathering of rocks releases arsenic-containing dust and allows arsenic compounds to enter groundwater. Arsenical compounds are used in industrial, agricultural, and medicinal substances. Arsenic is also an environmental contaminant in drinking water (well water) and the food chain and is an occupational hazard for miners and glass workers. Higher levels of arsenic are notoriously poisonous to multicellular life. Lower levels of inorganic arsenicals are known to be chemical carcinogens.

As early as 1888, Hutchinson reported skin cancer in patients who had taken arsenical medications. Numerous reports have since confirmed that ingested arsenic can cause Bowen disease (squamous cell carcinoma in situ); invasive squamous cell carcinoma; basal cell carcinoma of the skin; and (less frequently) internal cancers of the lung, the kidney, the bladder, and the liver.

Arsenic also causes pigment changes and (very frequently) hyperkeratotic lesions of the skin called arsenical keratoses. Arsenical keratoses are the most characteristic skin feature of long-term arsenic exposure.

Other Medscape articles related to arsenic include Neurological Manifestations of Arsenic Intoxication and Arsenic Toxicity in Emergency Medicine.

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