Diagnosis Name : Arsenical Keratosis

ICD10 : L85.8

Clinical Images

Histological Differential Diagnoses

References

These pointed, wart-like small papules present on the palms and soles in those with a history of arsenic exposure. When removed, a small depression is seen.
Identify and address source of exposure (e.g. contaminated drinking water) if the exposure is recent. Treatment options include: Surgical treatment (e.g. cryosurgery, curettage, excision). Topical immunomodulators (e.g. fluouracil) Oral retinoids Lifelong regular clinical followup should be advocated for all patients for screening for skin cancers and internal malignancies.
Epidermal acanthosis with hyperkeratosis. Cytologic atypia of keratinocytes which may vary from mild to full thickness atypia. Variable perivascular lymphocytic infiltrate.
BCC Syndromes, Transplant-Associated/Immunosuppression-Associated Non melanocytic Skin Cncer, PUVA Lentigines, Erythrodysplasia Verruciformis, Palmarplantar Keratoderma
Identify and address source of exposure (e.g. contaminated drinking water) if the exposure is recent. Treatment options include: Surgical treatment (e.g. cryosurgery, curettage, excision). Topical immunomodulators (e.g. fluouracil) Oral retinoids Lifelong regular clinical followup should be advocated for all patients for screening for skin cancers and internal malignancies.
Clinical features, in conjunction with history of exposure to arsenic, may highly suggest the diagnosis. Skin biopsy can be performed to confirm the diagnosis and to rule out arsenical Bowen’s disease and squamous cell carcinomas. Because arsenical keratosis may develop decades after arsenic exposure, further laboratory testing will not help with the diagnosis of arsenic keratosis, but will help in evaluating for the possibility of recent or current arsenic exposure and toxicity. Workup may include: CBC with differential, liver function tests, renal function tests, blood and urine arsenic levels. Arsenic levels in tissue, hair and nails can be performed, but may be normal if only distant exposure.
Identify and address source of exposure (e.g. contaminated drinking water) if the exposure is recent. Treatment options include: Surgical treatment (e.g. cryosurgery, curettage, excision). Topical immunomodulators (e.g. fluouracil) Oral retinoids Lifelong regular clinical followup should be advocated for all patients for screening for skin cancers and internal malignancies.
Identify and address source of exposure (e.g. contaminated drinking water) if the exposure is recent. Treatment options include: Surgical treatment (e.g. cryosurgery, curettage, excision). Topical immunomodulators (e.g. fluouracil) Oral retinoids Lifelong regular clinical followup should be advocated for all patients for screening for skin cancers and internal malignancies.