Arsenical keratosis explained

Specialty:Dermatology

Arsenical keratosis (AK) is growth of keratin on the skin caused by arsenic,[1] which occurs naturally in the Earth's crust and is widely distributed in the environment,[2] Arsenical compounds are used in industrial, agricultural, and medicinal substances. Arsenic is also found to be an environmental contaminant in drinking water (well water) and an occupational hazard for miners and glass workers.[3] Arsenic may also causes other conditions including: Bowen's disease,[4] cardiovascular diseases, developmental abnormalities, neurologic and neurobehavioral disorders, diabetes, hearing loss, hematologic disorders, and various types of cancer.[5] Arsenical keratoses may persist indefinitely, and some may develop into invasive squamous cell carcinoma. Metastatic arsenic squamous cell carcinoma and arsenic-induced malignancies in internal organs such as the bladder, kidney, skin, liver, and colon, may result in death.[5]

Definition

AK is a pre-cancerous skin condition caused by longterm poisoning with arsenic.[6]

Signs and symptoms

AK typically presents with small yellow corn-like warty bumps in the skin preceded by dark marks.[7] It is frequently seen on the sides of the palms of hands, and base and sides of fingers and feet.[7] The dark marks may look like 'raindrops' and these may be associated with Mees' lines across the nails.[7] The bumps typically appear 20 to 30 years after exposure to arsenic from usually a herbal medicine or contaminated water from wells.[7]

AK may precede the development of squamous cell carcinoma or basal cell carcinoma.[6] [8]

Pathophysiology

Arsenite impairs nucleotide excision repair,[9] and it may also affect gene expression by increasing or decreasing DNA methylation. The high affinity of arsenic for sulfhydryl groups makes keratin-rich cells (e.g., epidermal keratinocytes) a sensitive target for arsenic-induced toxicity. Arsenic has been shown to alter epidermal keratinocyte differentiation processes,[10] induce overexpression of growth factors,[11] and enhance proliferation of human keratinocytes.

Differential diagnosis

Actinic keratosis, seborrhoic keratosis, and squamous cell carcinoma in situ may appear similar.[7]

Treatment

Notes and References

  1. Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. .
  2. Duker AA, Carranza EJ, Hale M . Arsenic geochemistry and health . . 31 . 5 . 631–41 . July 2005 . 15910959 . 10.1016/j.envint.2004.10.020 .
  3. Book: James, William D. . Berger, Timothy G. . Andrews' Diseases of the Skin: clinical Dermatology . Saunders Elsevier . 2006 . 0-7216-2921-0 . etal.
  4. Yerebakan O, Ermis O, Yilmaz E, Basaran E . Treatment of arsenical keratosis and Bowen's disease with acitretin . . 41 . 2 . 84–7 . February 2002 . 11982642 . 10.1046/j.1365-4362.2002.01372.x. free .
  5. Tchounwou PB, Centeno JA, Patlolla AK . Arsenic toxicity, mutagenesis, and carcinogenesis--a health risk assessment and management approach . . 255 . 1–2 . 47–55 . January 2004 . 14971645 . 10.1023/B:MCBI.0000007260.32981.b9.
  6. Shajil . Chandana . Mahabal . Gauri D. . Arsenical Keratosis . StatPearls . 2024 . StatPearls Publishing.
  7. Book: DE . Elder . D . Massi . RA . Scolyer . R . Willemze . WHO Classification of Skin Tumours . 2018 . World Health Organization . Lyon (France) . 978-92-832-2440-2 . 4th . 11 . en . Premalignant keratoses: Arsenical keratosis . 52-53 .
  8. Book: James . William D. . Elston . Dirk . Treat . James R. . Rosenbach . Misha A. . Neuhaus . Isaac . Andrews' Diseases of the Skin: Clinical Dermatology . 2020 . Elsevier . Edinburgh . 978-0-323-54753-6 . 643 . 13th . https://books.google.com/books?id=UEaEDwAAQBAJ&pg=PA643 . en . 29. Epidermal nevi, neoplasms, and cysts: Arsenical keratosis .
  9. Hartwig A, Groblinghoff UD, Beyersmann D, Natarajan AT, Filon R, Mullenders LH . Interaction of arsenic(III) with nucleotide excision repair in UV-irradiated human fibroblasts . . 18 . 2 . 399–405 . February 1997 . 9054635 . 10.1093/carcin/18.2.399. free .
  10. Kachinskas DJ, Phillips MA, Qin Q, Stokes JD, Rice RH . Arsenate perturbation of human keratinocyte differentiation . . 5 . 11 . 1235–41 . November 1994 . 7848924 . 2009-02-09 . 2013-02-23 . https://archive.today/20130223104217/http://cgd.aacrjournals.org/cgi/pmidlookup?view=long&pmid=7848924 . dead .
  11. Germolec DR, Yoshida T, Gaido K . Arsenic induces overexpression of growth factors in human keratinocytes . . 141 . 1 . 308–18 . November 1996 . 8917704 . 10.1006/taap.1996.0288 . etal.
  12. Son SB, Song HJ, Son SW . Successful treatment of palmoplantar arsenical keratosis with a combination of keratolytics and low-dose acitretin . . 33 . 2 . 202–4 . March 2008 . 18039342 . 10.1111/j.1365-2230.2007.02596.x . https://archive.today/20130105085335/http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0307-6938&date=2008&volume=33&issue=2&spage=202 . dead . 2013-01-05 .
  13. Khandpur S, Sharma VK . Successful treatment of multiple premalignant and malignant lesions in arsenical keratosis with a combination of acitretin and intralesional 5-fluorouracil . . 30 . 10 . 730–4 . October 2003 . 14684956 . 10.1111/j.1346-8138.2003.tb00468.x . https://web.archive.org/web/20110722120942/http://www.dermatol.or.jp/Journal/JD/2003/030100730.html . dead . 2011-07-22 .
  14. Sharma SC, Simpson NB . Treatment of arsenical keratosis with etretinate . . 63 . 5 . 449–52 . 1983 . 6197851 .
  15. Boonchai W . Treatment of precancerous and cancerous lesions of chronic arsenicism with 5% imiquimod cream . . 142 . 4 . 531–2 . April 2006 . 16618886 . 10.1001/archderm.142.4.531.

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