Arsenicism is a systemic disease that can present with cutaneous, neurologic, andor gastrointestinal symptoms. Our primary purpose is to publish advances in pathology, in particular those applicable to clinical practice and contributing to the better. Arsenic is a well water contaminant, used in industrial, mining, agricultural pesticide and medicinal chemotherapy substances toxicol sci 2011. In this report, we describe a suspected case of palmoplantar arsenical keratosis in a patient from newfoundland, canada. Arsenical keratoses are usually present on the palms. Symptoms of chronic arsenic intoxication include general pigmentation or focal raindrop pigmentation of the skin and the appearance of hyperkeratosis of the palms of the hands and soles of the feet. The full text of this article is available as a pdf 242k. Acquired forms include arsenical keratoses and keratosis. In the skin arsenical poisoning can be manifested by three types of lesions.
Clinical report papular palmoplantar hyperkeratosis following chronic medical exposure to arsenic. Clinical and histopathological investigation of seborrheic keratosis nam kyung roh, hyung jin hahn1, yang won lee, yong beom choe, kyu joong ahn department of dermatology, konkuk university school of medicine, seoul, 1department of dermatology, uijeongbu st. Study on the histopathology of chronic arsenicosis semantic scholar. The patients are being followed up every six months to monitor cancer. Chronic arsenic poisoning is due to repeated or continuous exposure to arsenic compounds, which leads to an accumulation of arsenic in the body. It is largely of historic interest and occurred when arsenic and arsenicals were used to treat arthritis, asthma, psoriasis, syphilis, and other conditions. Radiation exposure exposure to certain chemicals such as arsenic certain genetic conditions such as xeroderma pigmentosum and gorlin syndrome it may. Punctate palmoplantar keratoderma ppk inherited keratodermas have central keratotic plugs that may be removed.
Exposure to radiation or certain substances, such as arsenic. May 14, 2007 histopathology skin actinic keratosis. In this video histology of arsenical keratosis is discussed. Only isolated incidences of cutaneous toxicity from environmental or medicinal exposure have been reported. Elsevier histopathology of cutaneous squamous cell. An extremely rare presentation of punctate keratoderma tasleem arif 1, mohammad adil 1, syed suhail amin 1, noora saeed 2 1 department of dermatology, stds and leprosy, jawaharlal nehru medical college, aligarh muslim university, aligarh, uttar pradesh, india 2 department of pathology, jawaharlal nehru medical college, aligarh muslim university, aligarh. Study on the histopathology of chronic arsenicosis journal of. Also called solar keratosis, senile keratosis buildup of excessive keratin due to chronic exposure to sunlight on sunexposed sites face, arms, dorsum of hands. Arsenical keratosis keratotic papules often found on the palms and soles associated with arsenic exposure.
What are the histologic findings characteristic of keratosis. Many cutaneous diseases with perturbed differentiation, including arsenical keratosis, show altered patterns of integrin distribution and expression. Actinic keratoses the histopathology is the same, but the location of the keratoses and cutaneous malignancies in sunprotected areas helps designate arsenic as the causative agent. Carcinoma, cutaneous horn, sebaceous cyst, seborrheic keratosis, squamous cell, stratum corneum access this article online. Arsenic keratosis in a patient from newfoundland and. Hyperkeratosis wo parakeratosis so no nucleiacanthosis thickening of basal and spinosum layer. Microscopic examination histopathology of keratosis pilaris kp lesions shows the triad of epidermal hyperkeratosis, hypergranulosis, and plugging of individual hair follicles. This study presents the case of a 38yearold patient from pakistan with vitiligo, who developed multiple verrucous papules on the palms and soles several years after receiving herbal treatment from a travelling indian doctor for a period of 12 months ncbi. Digitated seborrheic keratosis papillomatous projections, architecture mimics a verruca. Of these, keratosis is the most common, but it is hardly seen any longer because of the greatly decreased use of arsenical derivatives. Reports of eruptions accompanied by keratosis of the palms and soles caused by retention of arsenic, as proved by clinical observation and by the presence of arsenic in the urine, the blood and the skin and its appendages, are not uncommon in the. Molecularbiological examination of a skin biopsy detected. Age and sex distribution arsenical keratosis usually forms over many decades 2030 years. The efficacy of acitretin therapy was examined in two patients with cutaneous arsenical neoplasms.
Other discrete types of palmar keratoses which should be differentiated from those associated with cancer include verruca vul garis, dariers disease, keratosis palmaris. May 22, 2007 histopathology skin arsenical keratosis. Sign out skin lesion, midmiddle back, punch biopsy. There is no reliable method to distinguish arsenical keratoses from actinic keratoses. Patients and methods a total of 70 arsenicosis patients arsenic. Actinic keratosis arsenical keratoses february 5th, 2011 arsenical keratoses occur as lesions on the palms and soles that have a small pit in the skin with a central hyperkeratotic core that i occasionally encounter in my the woodlands dermatology and conroe dermatology offices. Keratosis punctata palmoplantaris kppp is a rare genodermatosis with an autosomaldominant pattern of inheritance. Arsenical keratosis secondary to fowler solution jaad. The few cases of arsenical keratosis in the united states have primarily been attributed to occupational and medicinal exposures. Arsenic is also found to be an environmental contaminant in drinking water and an occupational hazard for miners and glass workers. Pdf metastatic testicular cancer in a patient with. Introduction to department ofhistopathologyhistopathology is the department of clinical lab whichdeals with the study of diff types of tissuesthe department is based on following benches. The prognosis of arsenical keratosis is generally excellent with suitable early treatment.
Pdf effect of ethanol extract of leaves of azadirachta. Successful treatment of palmoplantar arsenical keratosis with a combination of keratolytics and lowdose acitretin. Arsenical keratosis wikimili, the free encyclopedia. An arsenical keratosis is a growth of keratin on the skin caused by arsenic, which occurs naturally in the earths crust and is widely distributed in the environment, arsenical compounds are used in industrial, agricultural, and medicinal substances. Curettage, cryotherapy, topical chemotherapeutic agents imiquimod, 5fu clinical images. Yerebakan o, ermis o, yilmaz e, basaran e 2002 treatment of arsenical keratosis and bowens disease with acitretin. An arsenical keratosis is a growth of keratin on the skin caused by arsenic. Papular palmoplantar hyperkeratosis following chronic. Here we report a rare case of arsenical keratosis presented with multiple polymorphic eruptions combined with chloracne. Diagnosis and treatment of chronic arsenic poisoning world health. Prolonged exposure of the body to arsenic results in damage of the dna, causing skin signs and symptoms.
Arsenical keratoses occur as lesions on the palms and soles that have a small pit in the skin with a central hyperkeratotic core that i occasionally encounter in my the woodlands dermatology and conroe dermatology offices. We describe here a case of 70yearold man to explore the clinical characters, diagnosis and treatment of medicationinduced arsenical keratosis in order to improve the understanding of this disease and reduce the misdiagnosis rate. Histopathology of verrucalike eruption above the upper. Treatment of arsenical keratosis and bowens disease with acitretin. A unique spectrum of skin lesions, known as arsenical keratosis, is rather characteristic of chronic. Good 80% clearance in keratoses was obtained, which is maintained after 15 months follow up. Chronic arsenic toxicity cat manifests predominantly as cutaneous lesions in the form of melanosis, keratosis and neoplastic changes. Case report arsenical keratosis caused by medication. We report the case of a 61yearold woman who presented with a long history of multiple symptomatic hyperkeratotic papules on the palms and soles. Three cutaneous cancers are associated with chronic exposure to arsenic. Clinical and histopathological investigation of seborrheic.
The topic arsenic exposure causing keratosis you are seeking is a synonym, or alternative name, or is closely related to the medical condition arsenical keratosis. Objectives to assess the spectrum of histopathological changes in arsenical keratoses. Over 10 million scientific documents at your fingertips. Arsenical squamous cell carcinoma occurs less frequently than bowen disease, but it appears to be more aggressive than suninduced squamous cell carcinoma. Seborrheic keratosis firbrown macules, papules, plaques, or polypoid lesions, often with a verrucous or stuckon appearance. Pattern of skin bacteria in palmar arsenical keratosis. Histopathological examination showed changes consistent with the diagnosis of arsenical keratosis. Punctate palmoplantar keratoderma ppk inherited keratodermas have central keratotic. Longterm exposure to arsenic is associated with the development of arsenical keratosis, bowens disease, squamous cell carcinoma, and basal cell carcinoma. Jtht yu and wy lam social hygiene service, department of health, hong kong jtht yu, bm, bchoxon, mrcpuk histopathology and cytology laboratory, public. Bowen disease is the most common form of skin cancer induced by arsenic exposure. Acute arsenic toxicity most commonly presents with. Histopathology is an international journal intended to be of practical value to surgical and diagnostic histopathologists, and to investigators of human disease who employ histopathological methods. Arsenical keratoses display mild to moderate keratinocyte atypia, severe hyperkeratosis, and scattered parakeratosis.
Aldehyde dehydrogenase 1 expression in basal cell carcinoma, actinic keratosis and bowens disease. Histopathology of verrucalike eruption above the upper lip showed. Pdf papular palmoplantar hyperkeratosis following chronic. Key differences identified between actinic keratosis and cutaneous squamous cell carcinoma by transcriptome profiling. The punctate ppks are subdivided into acquired and hereditary forms. A rare and interesting case report h r padmini1, nidhi pandey2 1professor and head, department of ophthalmology, adichunchanagiri institute of medical sciences, mandya, karnataka, india, 2post graduate, department of ophthalmology, adichunchanagiri institute of medical sciences, mandya, karnataka, india. Histopathology results of the ulcerated lesions of both patients were consistent with squamous cell carcinoma. The earliest and most common manifestations are dermatological, and therefore, recognition of hallmark lesions is key. Arsenic toxicity arsenicism, arsenicosis, arsenical. Additionally, some may develop into invasive squamous cell carcinoma. Human papillomavirus as a cofactor in the pathogenesis of arsenical keratosis. Hence, prompt recognition and treatment of the condition is necessary the treatment may involve the use of topical applications, laser therapy, and surgery. Histopathology of cutaneous squamous cell carcinoma brigid maguire, mbbs, frcpa, diprcpath. It can occur in normal skin, but often develops from precancerous lesions, particularly actinic keratoses and bowen disease, but also from actinic cheilitis, leukoplakia, radiation dermatitis, arsenical keratosis, xeroderma pigmentosum, chronic ulcers, burn scars, and erosive oral lichen 1, 3, 4.
Apr 02, 2018 arsenical keratosis and arsenicinduced skin cancers are very rare in the united states. Seborrheic keratosis of the external auditory canal in a 1yearold boy. Dermatopathology reference describes keratosis pilaris histopathology including histologic features and provides links to additional medical references. Arsenic also causes pigment changes and very frequently hyperkeratotic lesions of the skin called arsenical keratoses. Invasive squamouscell carcinoma and arsenical keratoses sarina b elmariah md phd, robert anolik md, ruth f walters md, karla rosenman md, miriam k pomeranz md, miguel r sanchez md dermatology online journal 14 10. A case of arsenical keratosis followed by cancer the. The keratoses under consideration con tainnone ofthesefeatures. Treatment of arsenical keratosis and bowens disease with. Pathogenesis, clinical features and pathology of chronic arsenicosis.
Arsenic exposure can occur through environmental or medicinal exposure. Arsenical keratosis occasionally evolves into carcinoma after a number of years. Medicationinduced arsenical keratosis is a rare type of arsenical keratosis. Bcc and two precursors of scc, bowens disease and arsenical keratosis other factors include. Arsenical keratosis is not a fatal disease, but it may persist indefinitely and can become bothersome over time because of pain, bleeding, fissuring, and ulceration. Irritated seborrheic keratosis spongiosis epidermal intercellular edema and inflammation.
Lumican as a novel marker for differential diagnosis of bowen disease and actinic keratosis. Arsenicosis, arsenic ingestion, arsenic contamination, chronic. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Surgical interventions, oral retinoids, and nutritional buildup were done. Arsenical keratosis, a keratotic skin disorder caused by chronic arsenic exposure, generally presents. Effect of ethanol extract of leaves of azadirachta indica on palmar arsenical keratosis. Treatment of arsenical keratosis and bowen disease with. Marys hospital, college of medicine, the catholic university of korea, uijeongbu, korea. Arsenical keratosis is considered precancerous, since it has the potential to progress into skin cancer. Pearls variablehistopathology, clinical3pathologycorrelationwitharsenicexposure varyfromseborrheic keratosis3likelesionstohyperplasticactinic.
A thorough history should be taken to evaluate for possible occupational, environmental, or therapeutic exposure. Chronic arsenical intoxication can still be found in environmental and industrial settings. Parakeratin is present on the surface of the lesion, and focal clear cell change is noted. Several epidemiologic studies of communities exposed to drinking water with higher arsenic levels have not shown any excess incidence of skin cancers. Keratosis punctata palmoplantaris controlled with topical. Lichenoid actinic keratosis has atypical hyperchromatic basal cells esp. Arsenicinduced keratosis definition of arsenicinduced. Pearls variablehistopathology, clinical3pathologycorrelationwitharsenicexposure varyfromseborrheic keratosis3likelesionstohyperplasticactinic keratosis. Jan 15, 2015 medicationinduced arsenical keratosis is a rare type of arsenical keratosis.
Squamous cell carcinoma secondary to arsenic keratoses in. Stucco keratosis pointed papillomatous projections. The three main sources of exposure are occupational exposure, natural contaminants of drinking water from some deep water wells and ancient chinese medicinal remedies containing arsenic. Histopathology of skin lesions in chronic arsenic toxicitygrading of. Invasive squamouscell carcinoma and arsenical keratoses. Elsevier histopathology of cutaneous squamous cell carcinoma. Role of linoleic acid in arsenical palmar keratosis. May 02, 2018 the treatment may involve the use of topical applications, laser therapy, and surgery. The thickened epidermis shows keratinoqte disorganization and a mild to moderate degree of cytologic atypia in the full epidermal thickness. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising. Thank you for your interest in spreading the word about the bmj. Often causes hyperkeratotic lesions of skin called arsenical keratoses. Adnexal structures are typically spared and basophilic degeneration of dermal connective tissue may or may not occur 30. Arsenicrelated bowens disease, palmar keratosis, and.
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