Skin-nontumor / Clinical dermatology
Other dermatoses

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

Revised: 23 June 2016, last major update July 2011

Copyright: (c) 2002-2016,, Inc.

PubMed Search: Arsenic [title] skin

Cite this page: Arsenic. website. Accessed June 21st, 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’s disease, squamous cell carcinoma, basal cell carcinoma and carcinomas of lung, bladder and kidney
  • Skin related problems are rare in US
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

Images hosted on other servers:

Arsenic related skin lesions

Rain drop pigmentation


Microscopic (histologic) description
  • Thick, compact hyperkeratosis and parakeratosis, resembling hypertrophic actinic keratoses (eMedicine)
  • Numerous vacuolated keratinocytes without solar elastosis are suggestive
  • May have atypia of keratinocytes
Microscopic (histologic) images

Images hosted on other servers:

Left: normal
Right: hyperkeratotic skin due to arsenic