ARSENICAL KERATOSES

Clinical

Hyperkeratotic papules may develop on the palms and soles years after arsenic ingestion. A mottled pigmentation may occur on the trunk like raindrops on a dirt road and Mees' lines may develop on the nails. SCC's, BCC's (especially of the pigmented type), gangrene of the feet, and in particular multiple BowenÂ’'s disease lesions are typical. The urine may be assayed for the presence of the arsenic which presently is occasionally found in well water in some parts of the world (e.g., Taiwan).

Systemic

Internal malignancy may also develop (most commonly liver and lung cancers). Nasal septum perforation is associated.

Treatment

Close monitoring and therapy of any cutaneous tumors is essential. Keratolytics, cryotherapy, CD, or 5-FU may be prescribed for the arsenical keratoses. A podiatrist to routinely debride the lesions is also helpful. Surveillance for internal malignancy is important.

References

Long 20-year history of these. Virtual Grand Rounds in Dermatology

Mottled pigmentation of the trunk. Nasza Dermatologia


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