Skin inflammatory (nontumor)
Keratinization disorders

Author: Cecilia Rosales, M.D. (see Authors page)

Revised: 22 October 2018, last major update July 2011

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Arsenic [title] skin

Cite this page: Rosales, C. Arsenic. website. Accessed December 12th, 2018.
Definition / general
  • Arsenic is a well water contaminant, used in industrial, mining, agricultural (pesticide) and medicinal (chemotherapy) substances (Toxicol Sci 2011;123:305)
  • Often causes hyperkeratotic lesions of skin called arsenical keratoses
  • Risk factor for Bowen disease, squamous cell carcinoma, basal cell carcinoma and carcinomas of lung, bladder and kidney
  • Skin related problems are rare in U.S.
Clinical features
  • Acute arsenical dermatitis or long term sequelae as a diffuse erythematous papular or pustular bullous dermatosis that can progress to exfoliative dermatitis
  • "Rain drops on a dusty road": hyperpigmented macules with small foci of hypopigmentation and darker hyperpigmentation in trunk, areola and flexural
  • Transverse white nail striations
  • Palmar and plantar keratoses 2+ years after exposure; may transform to Bowen’s disease, squamous cell carcinoma and superficial basal cell carcinoma
Clinical images

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Rain drop pigmentation


Microscopic (histologic) description
Microscopic (histologic) images

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Left: normal;
right: hyperkeratotic
skin due to arsenic