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Skin-nontumor / Clinical Dermatology

Other dermatoses


Reviewer: Cecilia Rosales, M.D., Baylor College (see Reviewers page)
Revised: 18 July 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Clinical features

● Arsenic is a well water contaminant, used in industrial, mining, agricultural (pesticide) and medicinal (chemotherapy) substances (Toxicol Sci 2011 Jul 12 [Epub ahead of print)
● Often causes hyperkeratotic lesions of skin called arsenical keratoses
● Risk factor for Bowen’s disease, squamous cell carcinoma, basal cell carcinoma and carcinomas of lung, bladder and kidney
● Skin related problems are rare in US

Clinical description

● Acute arsenical dermatitis or long term sequelae as a diffuse erythematous papular or pustular bullous dermatosis that can progress to exfoliative dermatitis
● "Rain drops on a dusty road": hyperpigmented macules with small foci of hypopigmentation and darker hyperpigmentation in trunk, areola and flexural
● Transverse white nail striations
● Palmar and plantar keratoses 2+ years after exposure; may transform to Bowen’s disease, squamous cell carcinoma and superficial basal cell carcinoma

Clinical images

Arsenic related skin lesions

Rain drop pigmentation


Microscopic description

● Thick, compact hyperkeratosis and parakeratosis, resembling hypertrophic actinic keratoses (eMedicine)
● Numerous vacuolated keratinocytes without solar elastosis are suggestive
● May have atypia of keratinocytes

Micro images

Left: normal, right: hyperkeratotic skin due to arsenic

Virtual slides

Arsenical keratosis

End of Skin-nontumor / Clinical Dermatology > Other dermatoses > Arsenic

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