Abstract
The study was designed to see the effects of tetracycline and clotrimazole on the altered skin flora (Aspergillus and Enterobacter species) in 38 patients with palmar arsenical keratosis. The skin swab and scrapping samples were collected. Tetracycline, clotrimazole and their combination were given as ointment for 3 months. Clotrimazole and tetracycline were found to inhibit the growth of Aspergillus spp. and Enterobacter spp. in vitro. A pH-dependent inhibition of the growth of microorganisms in presence of these antimicrobials was observed, which was highest at pH 8. The percentage reduction of keratotic nodular size was 32.9, 66.1, 61.1 and 32.5 in the groups treated with placebo, tetracycline, clotrimazole and the combination of both, respectively. But none of the interventions was proved statistically significant. No remarkable adverse effect was reported. In conclusion, clotrimazole or tetracycline inhibits the growth of Aspergillus spp. or Enterobacter spp. in vitro. However, there was no statistically significant clinical improvement of the palmar arsenical keratosis.
Highlights
Exposure to arsenic through contaminated groundwater is a major public health problem worldwide (Khan et al, 1997)
The present study was intended to propose or generate a hypothesis that the alteration of skin microbial flora may cause the development of keratosis
Three patients complained about adverse effects which were not significant and subsided spontaneously. This is the first report showing the effect of topical antimicrobials in the treatment of palmar arsenical keratosis
Summary
Exposure to arsenic through contaminated groundwater is a major public health problem worldwide (Khan et al, 1997). Despite exposure to the same source of arsenic-contaminated groundwater, not all the members of the family get affected by arsenicosis. It had been found in certain studies that there is an alteration of normal skin flora in arsenicosis, where Aspergillus spp. and Enterobacter spp. were found to be significantly present on the palm of the patients with arsenical keratosis in comparison to the control population (Khalil et al, 2016; Moitra et al, 2018). The relationship between such altered skin flora and the development of arsenical keratosis is not established or explored
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