Arsenical Keratosis Research Articles

Arsenical keratosis in China: A case report and review of the literature.

Arsenical keratosis is a precancerous dermatosis which could be induced by long-term exposure to arsenic poisoning. Arsenic is often added to traditional Chinese medicine in a non-compliant manner to increase the effectiveness of psoriasis treatment, which is often the main cause of arsenic poisoning in Chinese patients with psoriasis. We performed a systemic review of arsenic keratosis during the past 32 years to better understand the sources, treatment, and prognosis of arsenic keratosis in China. We searched Medline/PubMed, Embase, CNKI, and Wanfang databases for research studies published between 1992 and 2024. A total of 64 papers with 78 individual Chinese of arsenical keratosis were included in this analysis. Of the patients included in the analysis, 92.21% of arsenic poisoning was due to iatrogenic factors: Chinese traditional medicine. Seventy-six patients (98.70%) had skin manifestation of hyperkeratotic papules and plaques, 68 patients (88.31%) had hyperpigmentation, 43 cases (55.84%) had hypopigmentation, and only 4 had a clear indication of Mees' lines in nails. A total of 52.63% of patients presented with tumors, including squamous cell carcinoma, Bowen's disease, and basal cell carcinoma. For patients with tumors, 20 opted for surgery, 6 for radiotherapy, and 3 for PDT. All patients with only cutaneous tumors are currently well-controlled. Death occurred in one patient with metastatic squamous cell carcinoma. Keratinizing papules improved significantly in 70.59% of patients treated with Acitretin Capsules. In this study, arsenic sources in Chinese patients were mainly from traditional Chinese medicine, and there were no reports of exposure to water sources or occupational sources in the past 32 years. Most of the patients showed keratinizing papules and pigmentation, and more than 1/2 of the patients showed skin tumors, mainly squamous cell carcinoma. The treatments of tumors are mainly surgical treatment, PDT and radiotherapy can also be selected. The improvement in keratinizing rash was greater than 70% with acitretin capsules. Patients with this disease should be regularly followed up for early detection and timely treatment of potential malignant tumors.

Arsenical Keratosis with Unusual Lung Involvement.

Arsenical Keratosis with Unusual Lung Involvement.

Prevalence of Skin Cancer in Chronic Arsenicosis in Chittagong Medical College Hospital, Bangladesh

A descriptive study was done in the Department of Dermatology and Venereology; Chittagong Medical College Hospital, Chittagong, during the period of July 2004 to June 2008, to find out the prevalence of skin cancer among various skin manifestations of chronic arsenicosis. All suspected patients of chronic arsenicosis coming from endemic zones of Bangladesh were the study population. A total number of 234 patients of chronic arsenicosis were included in this study. The patients were diagnosed by physical examination and by estimation of arsenic level of scalp hair. The majority of the patients came from Noakhali, Chitagong, Feni, Laxmipur, Comilla and Chandpur districts. The mean age of the patients was 27.80 years ± 10.22 SD (Range: 12-70 years). About 70% patients were around 30 years of age. The male & female ratio was 1.9: 1. Most of them came from average socio-economic status. About 28.6 % patients were students, while about 25% patients were daily labour. 94 % patients used tube well as drinking water source. 12.8o patients had family history of chronic arsenicosis and about 19% patients took alternative medicines (homeopathic /kobirajee) for treatment of the same or other illness. The cent percent patients presented with hypo and hipermelanosis (rain drop pigmentation), while 90,6 % patients were with hyperkeratosis in palms and soles. The measurement of arsenic in scalp hair was done. The mean arsenic level of scalp hair was found to be 2.63 1.39 SD (range: 2.0 - 17.6 mg/kg). Skin biopsy for histopathology was done for suspected patients and skin lesions of 21.4% patients were detected as arsenical keratosis. Among the total patients, 6 (six) patients were found to develop skin cancers (2.6 %). Among them, 3 patients developed Squamous Cell Carcinoma (SCC), 1 patient developed Basal Cell Carcinoma (BCC), while Bowen's disease and Melanoma was found in I patient each. Regarding treatment response, about 48% patients showed good response with topical ........

A Squamous Cell Carcinoma Presenting as a Giant Cutaneous Horn over the Lower Lip in a Patient with Chronic Disseminated Lupus Erythematosus.

A Squamous Cell Carcinoma Presenting as a Giant Cutaneous Horn over the Lower Lip in a Patient with Chronic Disseminated Lupus Erythematosus.

Evaluation of Clinical Knowledge Regarding Geriatric Skin Conditions among Thai Physicians

Objective: Assess the knowledge of common geriatric skin conditions in Thai physicians.Materials and Methods: This retrospective study was conducted among Thai physicians attending annual dermatology courses by the Dermatological Society of Thailand from 2016 to 2019. Data was assessed based on knowledge of diagnosis and management of common geriatric skin conditions.Results: A total of 197 participants, mainly general practitioners, were included. The highest percentage of correct diagnoses were benign erythematous, eczematous lesions (35.5%, senile purpura; 36.0%, xerotic eczema), and malignant diseases (35.5%, basal cell carcinoma; 27.4%, squamous cell carcinoma; 11.7%, subungual melanoma; 24.4%, acral lentiginous melanoma). In contrasts, the lowest percentage of correct diagnosis were premalignant diseases (0.5%, arsenical keratosis; 4.6%, actinic keratosis; 1.0% Bowen’s disease) and benign hypopigmented lesion (0.5%, stellate pseudoscar; 7.6%, idiopathic guttate hypomelanosis). Harmful treatment with systemic antifungal therapy was used in subungual melanoma (58.0%). Harmful management of senile comedone, subungual melanoma and acral lentiginous melanoma was significantly found in physicians given the incorrect diagnosis. (p = 0.027, p <0.001, p = 0.014, respectively).Conclusion: Most physicians recognized malignant lesions, benign erythematous or eczematous diseases in elderly skin. Surprisingly, almost all physicians couldn’t diagnose premalignant lesions and benign hypopigmented lesions.

The Therapeutic Effects of Nigella sativa on Skin Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The aim of this systematic review was to identify randomized controlled trials that looked at the effects of Nigella sativa in any form on different skin diseases. Up to March 2022, the online databases of Scopus, Web of Science, PubMed, Embase, Google Scholar, and Cochrane trials were searched. This study included 14 records of people who had experienced different types of skin disease including atopic dermatitis, vulgaris, arsenical keratosis, psoriasis, vitiligo, acute cutaneous leishmaniasis, warts, eczema, and acne. The mean SD age of the patients was 28.86 (4.49); [range: 18.3-51.4], with females accounting for 69% (506 out of 732) of the total. The follow-up mean SD was 8.16 (1.3) (ranged: 4 days to 24 weeks). The odds ratio (OR) was found to be 4.59 in a meta-analysis (95% CI: 2.02, 10.39). Whereas the null hypothesis in this systematic review was that lotion had no impact, OR 4.59 indicated that lotion could be effective. The efficacy of N. sativa essential oil and extract has been demonstrated in most clinical studies. However, more research is needed to completely evaluate and validate the efficacy or inadequacy of therapy with N. sativa, although it appears that it can be used as an alternative treatment to help people cope with skin problems.

Arsenical Keratoses

Arsenic occurs naturally in the earth's crust, widely distributed in the environment, in drinking water, used in various industrial, agricultural & medicinal substances & is a occupational hazard for miners and glass workers. Arsenic impairs nucleotide excision repair, affect DNA methylation. Chronic exposure of arsenic leads to arsenical keratosis, which usually presents as multiple hyperkeratotic, punctuate lesions, occurs at sites of friction and trauma especially on palms and soles and on chronically light exposed skin. They resemble Bowen's disease microscopically and may progress to squamous cell carcinoma or basal cell carcinoma. Topical 5-FU, 5% Imiquimod and oral retinoids may be helpful in treating arsenic induced cutaneous lesions. Arsenical keratosis in a patient of non endemic area of Amritsar region, makes this case worth reporting.

Patient-Reported Outcomes of Arsenic-Related Skin Lesions in China.

Purpose Previous studies confirmed that chronic arsenic exposure could lead to pigmentary changes and hyperkeratosis. However, skin health-related quality of life (HRQoL) among people under lifetime arsenic exposure remains underappreciated. Our study is aimed at investigating several patient-reported outcomes in a population under chronic arsenic exposure. Patients and Methods. A cross-sectional study was conducted in communities in Shimen, China. Dermatologists performed skin examinations for participants. Patient-reported outcomes (PROs) included HRQoL, itch, sleep quality, and symptoms of anxiety and depression. The Dermatology Life Quality Index (DLQI) was used to measure skin HRQoL. The numerical rating scale (NRS) was used to measure the intensity of itching. Sleep disturbance was measured by Pittsburgh Sleep Quality Index (PSQI). Anxiety and depression were measured by two-item Generalized Anxiety Disorder (GAD-2) and Patient Health Questionnaire (PHQ-2), respectively. Results A total of 464 participants suffering from arsenic-related skin lesions finished the assessment of DLQI. Pigmentary changes and arsenical keratosis were not associated with the patient-reported outcomes except PHQ-2. Hair arsenic exceeding 1 μg/g was associated with higher itch NRS and DLQI (P < 0.05). Itch NRS (adjusted β = 0.80, 95% CI: 0.70–0.90, P < 0.01) and hair arsenic concentration (adjusted β = 0.12, 95% CI: 0.01–0.24, P < 0.05) were independently associated with the DLQI. Conclusion HRQoL, sleep quality, and mental wellbeing are impaired in residents under chronic arsenic exposure. Itching and hair arsenic are independent risk factors for impaired HRQoL.

Effects of solasodine of Solanum melongena peel origin in the treatment of palmar arsenical keratosis

This study was conducted to confirm the effect of the ointment containing Solanum melongena peel extract in the treatment of palmar arsenical keratosis and to identify the compound responsible for the effect. In total, 30 patients with moderate to severe palmar arsenical keratosis were enrolled according to the inclusion criteria. Extract from S. melongena peel was obtained and a topical ointment was prepared from the extract and supplied at the field level at an interval of two weeks. Instruction was given to the patients about how to apply the ointment. Adherence and adverse effects of the treatment were monitored regularly through phone calls and during each visit. The mean (± SD) size of the keratotic nodules was 21.9 ± 10.0 mm2 before intervention and 6.6 ± 5.3 mm2 after intervention. The percentage of reduction was 69.8. Nuclear magnetic resonance spectroscopy, infrared spectroscopy, liquid chromatography-mass spectrometry and elemental analysis of the extract was done to identify the compound and solasodine, a steroidal alkaloid, was identified.

Effects of tetracycline and clotrimazole ointments in the treatment of palmar arsenical keratosis

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.

Compound isolated from the cock’s comb and its effect on palmar arsenical keratosis

This study was conducted to confirm the effectiveness of the ointment containing cock’s comb extract and to identify the compound that was effective in the treatment of palmar arsenical keratosis. On the basis of inclusion and exclusion criteria, 24 patients with moderate to severe palmar arsenical keratosis were enrolled from an arsenic endemic area. The ointment prepared from the cock’s comb extract was supplied to each patient at an interval of 2 weeks. Each patient was advised to apply the ointment on the nodule by rubbing gently up to 5 minutes and twice daily for 12 weeks. Improvement was monitored by measuring the nodular size before starting and after completion of the treatment. The mean (± SD) size of the nodules of the palm before treatment was 16.6 ± 5.0 mm2, which was reduced to 4.0 ± 3.8 mm2 after completion of the treatment. This reduction was statistically significant. To identify the effective compound nuclear magnetic resonance spectroscopy, infrared spectrophotometry, elemental analysis and liquid chromatography-mass spectroscopy of the extract were done yet conclusion could not be achieved.

Effect of Solanum melongena peel extract in the treatment of arsenical keratosis

This study was conducted to examine the effect of the ointment containing Solanum melongena peel extract in the treatment of arsenical keratosis. In total, 23 patients were enrolled on the basis of inclusion and exclusion criteria. The ointment was given to each patient and advised him/her to apply to the site of lesion twice daily for 12 weeks without any gap. The size of the lesion and its photograph were collected before and at the end of the study. The mean (± SD) diameter of the lesion was 3.9 ± 2.1 cm which reduced to 1.8 ± 1.3 cm (reduction 54%). The results were statistically significant. In conclusion, S. melongena peel extract is found to be effective in the treatment of arsenical keratosis.

Effect of cock’s comb extract in the treatment of palmar arsenical keratosis

The aim of this study was to examine the effect of cock’s comb extract in the treatment of moderate palmar arsenical keratosis (n = 35). All the patients were provided cock’s comb extract ointment to apply topically twice daily for 12 weeks. Adherence to the ointment and adverse effects were monitored regularly through the phone call and during the visit of each patient. Photographs of both palms were collected before and after treatment. Clinical improvement was assessed by measuring the arsenical keratotic nodular size of the both palms before starting the treatment and after completion of the treatment. The mean (± SD) sizes of the nodules before the study was 33.6 ± 16.8, which reduced to 5.4 ± 5.2 after completion of the study. This change (84% reduction) was statistically significant. None of the patients reported to any adverse effect during this study period. In conclusion, cock’s comb extract can be used effectively as a topical treatment of the palmar arsenical keratosis.&#x0D;

Arsenicosis Presenting with Cutaneous Squamous Cell Carcinoma: A Case Report

A 29-year-old male with eleven-year history of hyperkeratotic papules and speckled pigmentation developed cutaneous squamous cell carcinoma. Arsenicosis was confirmed by elevated hair arsenic level, and histopathologic findings of arsenical keratosis and one lesion showing carcinoma-in-situ. Chronic arsenic exposure has been found to activate inflammatory and carcinogenic pathways leading to development of pre-malignant and malignant lesions. A multi-disciplinary approach involving healthcare specialists and environmentalists is crucial in source control and management of long-term complications.

Pattern of skin fungi in palmar arsenical keratosis

&lt;p class="Abstract"&gt;The aim of this study was to examine the pattern of fungi in palmar arsenical keratosis. The skin swab was taken from the five different sites (palm, dorsum, axilla, front and back of the chest) of arsenicosis patients (n=37), arsenic exposed volunteers (n=20) and healthy volunteers (n=20) of an arsenic endemic area. Fungi were cultured in the Sabouraud dextrose agar media. The skin of the healthy volunteers contained only four species of fungi: Aspergillus, Dermatophytes, Mucor and Fusarium. The incidence of each fungus was low (0-4 out of 20 cases). The chronic exposure to arsenic did not alter the pattern of fungi. However, the patient of arsenicosis showed increased inci-dence of Aspergillus and Dermatophytes species and decreased incidence of Mucor species. The supplementation of iron and folic acid to the patient for 12 weeks reduced the incidence of Aspergillus (only in axilla), Dermatophytes (only in palm) and increased the incidence of Mucor (all the sites except palm). In conclusion, skin fungi are altered in arsenicosis irrespective of intake of high concentration of arsenic.&lt;/p&gt;

Increased count of &lt;i&gt;Bacteroides fragilis&lt;/i&gt; in the feces of palmar arsenical keratosis patient

&lt;p class="Abstract"&gt;Chronic exposure to high concentration of arsenic caused an increase in the colony count of &lt;em&gt;Bacteroides fragilis&lt;/em&gt; in the feces in comparison to healthy volunteer (3.6 × 10¹¹ ± 1.9 vs 1.5 × 10¹¹ ± 1.7 CFU/g of feces) which was not statistically significant. But significant increase in the colony count of &lt;em&gt;B. fragilis&lt;/em&gt; was seen in the feces of palmar arsenical keratosis patient (4.2 × 10¹¹ ± 1.9 CFU/g of feces; p=0.0390). Supplementation with probiotic for 12 weeks decreased the colony counts in all three groups which were not statistically significant among the groups. Probiotics decreased the amount of arsenic in the nail of all the three groups significantly.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Role of linoleic acid in arsenical palmar keratosis.

Chronic arsenic exposure can lead to palmoplantar keratosis. In the stratum corneum of skin, linoleic acid is of the utmost importance to the inflammation, keratinization, and regeneration processes. The aims of this study were: (i) to present quantitative information on the linoleic acid fraction of intercorneocyte lipids, and (ii) to elucidate the role of linoleic acid in the pathophysiology of arsenical keratosis. Lipid extracts were collected from keratotic lesions in seven patients, seven arsenic-exposed subjects, and seven non-exposed control subjects. Linoleic acid levels of the specimens were estimated by reverse-phase high-performance liquid chromatography (RP-HPLC). There was a significant (P < 0.001) increase in mean ± standard error (SE) linoleic acid levels in arsenical keratosis patients (palm: 25.66 ± 4.95 μg/cm(2); dorsum: 28.25 ± 6.20 μg/cm(2)) compared with arsenic-exposed (palm: 2.75 ± 0.85 μg/cm(2); dorsum: 1.96 ± 0.64 μg/cm(2)) and non-exposed (palm: 1.52 ± 0.61 μg/cm(2); dorsum: 1.28 ± 0.39 μg/cm(2)) control subjects. There was no significant difference (P = 0.556) in linoleic acid concentration in the non-affected skin of the dorsum of the hand (28.25 ± 6.20 μg/cm(2)) compared with that in the palmar sites (25.66 ± 4.95 μg/cm(2)) in the patient group. The change in linoleic acid levels in the arsenic-exposed control group did not differ from that in non-exposed controls (P = 1.000). Linoleic acid concentration is elevated in arsenical keratosis; this finding warrants further investigation to ascertain whether linoleic acid plays a direct role in the pathophysiology of arsenical keratosis.

Effect of ethanol extract of leaves of &lt;i&gt;Azadirachta indica&lt;/i&gt; on palmar arsenical keratosis: A single-blind trial

The effectiveness of topical application of ethanol extract of Azadirachta indica (neem) daily for 12 weeks was examined in patient of palmar arsenical keratosis. The mean (± SD) score of size of nodules of patients (n=14) using salicylic acid alone before and after treatment were 14.6 ± 4.6 and 10.5 ± 4.5 respectively (28.1% improvement). The mean score of size of nodules of patients (n=15) using salicylic acid plus A. indica (ethanol extract) before treatment was 14.7 ± 4.6 which was decreased to 3.1 ± 2.2 after treatment (79% improvement). The perception score of salicylic acid-treated group was 2.1 whereas it was increased to 4.7 in A. indica plus salicylic acid-treated group. Based on palmar nodular size and patients perception it can be concluded that topical use of ethanol extract of A. indica is effectively in palmar arsenical keratosis.

The colony count of &lt;i&gt;Escherichia coli&lt;/i&gt; in the stool of palmar arsenical keratosis following probiotics supplementation

The role of probiotics supplementation for 12 weeks on the colony count of Escherichia coli in the stool of moderate palmar arsenical keratosis (14), arsenic exposed controls (15) and healthy volunteers (9) were studied. The mean colony counts of E. coli in the stool of arsenic exposed controls and patients were reduced to 7.3 x 1011 CFU/g and 3.2 x 1011 CFU/g respectively in comparison to healthy volunteers (11.1 x 1011 CFU/g). After probiotics supplementation, the E. coli count was significantly increased in patients (p=0.000) and arsenic exposed controls (p=0.000) in comparison to healthy volunteers (p=0.027). Patients excreted less arsenic through stool and supplementation with probiotics showed increased excretion of arsenic only in patients The level of arsenic in nail of patients was more than the arsenic exposed controls and healthy controls. Probiotics supplementation did not show any significant change. This study suggests that arsenicosis reduced the stool colony count of E. coli, less excretion of arsenic and probiotics supplementation reversed the processes.

A double-blind, randomize, placebo-control trial to evaluate the effect of &lt;i&gt;Nigella sativa&lt;/i&gt; on palmer arsenical keratosis patients

This study was done to examine the role of Nigella sativa in 28 patients of palmer arsenical keratosis. Patients were randomized into two groups: Group A (n-15) receive capsules of placebo and vitamin E (200 mg) whereas Group B (n= 13) receive capsules of N. sativa oil (500 mg) and vitamin E (200 mg) orally for 8 weeks. The mean (± SD) clinical scoring of palmer arsenical keratosis in Group A before and after treatment was 99.3 ± 21.5 and 62.3 ± 14.3 respectively (37% reduction). On the other hand, in N. sativa oil treated group, the mean clinical score was 119.1 ± 20.3 before treatment which was reduced to 39.2 ± 8.4 (p<0.0001) after treatment (67% reduction). There were 65% reduc-tion of total arsenic in nail of Group A and 30% in Group B. In conclusion, oral administration of N. sativa oil improves the symptom of palmer arsenical keratosis as a result of reduction of body arsenic load. DOI: http://dx.doi.org/10.3329/bjp.v9i1.17167 Bangladesh J Pharmacol 2014; 9: 15-21