Arsenical Keratosis

Excerpt

Arsenical keratosis is a precancerous dermatosis observed in patients with chronic arsenic toxicity. This condition is characterized by corn-like, yellowish, hyperkeratotic papules and plaques, primarily affecting the palms and soles. Often, it starts as small areas of hyperkeratosis, which increase in number and size to involve the entire palms and soles. In rare cases, it can spread to the dorsal surfaces of the hands and feet and other parts of the body and may progress to squamous cell carcinoma (SCC).

Arsenical keratosis with skin hyperpigmentation is the earliest and most common presenting complaint in chronic arsenic toxicity. Therefore, it plays a crucial role in guiding clinicians toward the early diagnosis and treatment of chronic arsenic toxicity. Apart from benign conditions such as skin hyperpigmentation and Mees' lines in the nails, arsenical keratosis can sometimes coexist with single or multiple lesions of Bowen's disease, basal cell carcinoma, and SCC. Identification and elimination of the source of arsenic exposure are of utmost importance, as these patients are at a high risk of developing multisystem disorders and visceral malignancies.