Arsenical Keratosis Treatment & Management

Updated: Apr 02, 2018
  • Author: Chih-Shan Jason Chen, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Arsenical keratoses show thick, compact hyperkeratosis and parakeratosis similar to hypertrophic actinic keratoses. Some epidermal keratinocytes may show atypia histologically. [34] The presence of numerous vacuolated keratinocytes and the absence of solar elastosis are suggestive of arsenical keratoses, but these findings are not absolute criteria.

Retinoidlike agents decrease the cohesiveness of abnormal hyperproliferative keratinocytes and may reduce the potential for malignant degeneration. [35, 36]

Topical imiquimod has been reported to show some efficacy. [37]

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Surgical Care

Surgical removal or destruction (eg, excision, curettage, cryosurgery, dermatome shaving [38] ) is usually the treatment of choice.

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Consultations

Consult a dermatologist for a total body skin examination and screening for skin cancer. Consult an internist for a complete physical examination and a review of systems. Further workup is indicated if an internal malignancy is suspected.

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Diet

Avoiding dietary intake of arsenic and consuming purified water instead of arsenic-contaminated drinking water are effective ways to reduce the damage of arsenic toxicity.

Evidence suggests individual nutritional status may determine the severity of health effects resulting from long-term arsenic exposure. [39] A well-balanced diet and supplements of folate and selenium may have modifying effects on arsenic toxicity. [7]

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Prevention

Educate patients on early detection and avoidance of arsenic exposure. Identify possible exposure sources in the environment (eg, arsenic-contaminated drinking water, plywood containing arsenic). Advise patients to avoid taking herbal medicine with uncertain arsenic content. Evidence suggests smoking may have additional effect on arsenic induced skin lesions. Smoke cessation and sun protection may modify the damage of arsenic toxicity. [7]

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Long-Term Monitoring

Regular skin surveillance and physical examination are necessary for patients who present with cutaneous lesions of chronic arsenicalism because aggressive squamous cell carcinoma may evolve de novo or from existing arsenical keratoses or Bowen disease.

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