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.

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.^[43]A well-balanced diet and supplements of folate and selenium may have modifying effects on arsenic toxicity.^[17]

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.^[17]

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.

Medication

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Banerjee M, Sarma N, Biswas R, Roy J, Mukherjee A, Giri AK. DNA repair deficiency leads to susceptibility to develop arsenic-induced premalignant skin lesions. Int J Cancer. 2008 Jul 15. 123(2):283-7. [QxMD MEDLINE Link].
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Tay CH. Cutaneous manifestations of arsenic poisoning due to certain Chinese herbal medicine. Australas J Dermatol. 1974 Dec. 15(3):121-31. [QxMD MEDLINE Link].
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Media Gallery

Arsenical keratosis on the sole of a carpenter.

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Author

Chih-Shan Jason Chen, MD, PhD Attending Physician, Dermatology Service, Memorial Sloan-Kettering Cancer Center; Director, Dermatologic Surgery and Mohs Micrographic Surgery Unit, MSK Skin Cancer Center; Chief, Dermatologic Surgery, Northport Veterans Affairs Medical Center; Associate Professor of Clinical Dermatology, Stony Brook University School of Medicine

Chih-Shan Jason Chen, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery, Association of Professors of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel Mark Siegel, MD, MS Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Association for Physician Leadership, American Society for Dermatologic Surgery, American Society for MOHS Surgery, International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Arsenical Keratosis Treatment & Management

Consultations

Diet

Prevention

Long-Term Monitoring

References

Tables

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