Curettage, cryotherapy, topical chemotherapeutic agents imiquimod, 5fu clinical images. The prognosis of arsenical keratosis is generally excellent with suitable early treatment. Yerebakan o, ermis o, yilmaz e, basaran e 2002 treatment of arsenical keratosis and bowens disease with acitretin. Sign out skin lesion, midmiddle back, punch biopsy. Elsevier histopathology of cutaneous squamous cell. Treatment of arsenical keratosis and bowen disease with. Thank you for your interest in spreading the word about the bmj. A thorough history should be taken to evaluate for possible occupational, environmental, or therapeutic exposure. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising.
A unique spectrum of skin lesions, known as arsenical keratosis, is rather characteristic of chronic. 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. Adnexal structures are typically spared and basophilic degeneration of dermal connective tissue may or may not occur 30.
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. Arsenical keratoses are usually present on the palms. Good 80% clearance in keratoses was obtained, which is maintained after 15 months follow up. Histopathology of verrucalike eruption above the upper. Arsenical keratosis occasionally evolves into carcinoma after a number of years. The keratoses under consideration con tainnone ofthesefeatures. Diagnosis and treatment of chronic arsenic poisoning world health. Clinical report papular palmoplantar hyperkeratosis following chronic medical exposure to arsenic. Lumican as a novel marker for differential diagnosis of bowen disease and actinic keratosis. Pathogenesis, clinical features and pathology of chronic arsenicosis. Pearls variablehistopathology, clinical3pathologycorrelationwitharsenicexposure varyfromseborrheic keratosis3likelesionstohyperplasticactinic keratosis. 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. Arsenic exposure can occur through environmental or medicinal exposure. Hence, prompt recognition and treatment of the condition is necessary the treatment may involve the use of topical applications, laser therapy, and surgery.
Longterm exposure to arsenic is associated with the development of arsenical keratosis, bowens disease, squamous cell carcinoma, and basal cell carcinoma. In the skin arsenical poisoning can be manifested by three types of lesions. 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. Arsenical keratosis wikimili, the free encyclopedia. Digitated seborrheic keratosis papillomatous projections, architecture mimics a verruca. Arsenicinduced keratosis definition of arsenicinduced. Parakeratin is present on the surface of the lesion, and focal clear cell change is noted. Arsenicism is a systemic disease that can present with cutaneous, neurologic, andor gastrointestinal symptoms. Squamous cell carcinoma secondary to arsenic keratoses in.
Seborrheic keratosis firbrown macules, papules, plaques, or polypoid lesions, often with a verrucous or stuckon appearance. Seborrheic keratosis of the external auditory canal in a 1yearold boy. It is largely of historic interest and occurred when arsenic and arsenicals were used to treat arthritis, asthma, psoriasis, syphilis, and other conditions. Over 10 million scientific documents at your fingertips. The few cases of arsenical keratosis in the united states have primarily been attributed to occupational and medicinal exposures. Histopathology results of the ulcerated lesions of both patients were consistent with squamous cell carcinoma. Dermatopathology reference describes keratosis pilaris histopathology including histologic features and provides links to additional medical references. Pdf effect of ethanol extract of leaves of azadirachta. Exposure to radiation or certain substances, such as arsenic.
Arsenic toxicity arsenicism, arsenicosis, arsenical. Arsenical keratosis keratotic papules often found on the palms and soles associated with arsenic exposure. Arsenical keratoses display mild to moderate keratinocyte atypia, severe hyperkeratosis, and scattered parakeratosis. Invasive squamouscell carcinoma and arsenical keratoses. 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. Chronic arsenic toxicity cat manifests predominantly as cutaneous lesions in the form of melanosis, keratosis and neoplastic changes. Jtht yu and wy lam social hygiene service, department of health, hong kong jtht yu, bm, bchoxon, mrcpuk histopathology and cytology laboratory, public. Apr 02, 2018 arsenical keratosis and arsenicinduced skin cancers are very rare in the united states. Other discrete types of palmar keratoses which should be differentiated from those associated with cancer include verruca vul garis, dariers disease, keratosis palmaris. Human papillomavirus as a cofactor in the pathogenesis of arsenical keratosis. Bcc and two precursors of scc, bowens disease and arsenical keratosis other factors include.
Pdf metastatic testicular cancer in a patient with. 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. Our primary purpose is to publish advances in pathology, in particular those applicable to clinical practice and contributing to the better. The thickened epidermis shows keratinoqte disorganization and a mild to moderate degree of cytologic atypia in the full epidermal thickness. Patients and methods a total of 70 arsenicosis patients arsenic. An arsenical keratosis is a growth of keratin on the skin caused by arsenic. Medicationinduced arsenical keratosis is a rare type of arsenical keratosis. Arsenical keratosis, a keratotic skin disorder caused by chronic arsenic.
Prolonged exposure of the body to arsenic results in damage of the dna, causing skin signs and symptoms. Chronic arsenic poisoning is due to repeated or continuous exposure to arsenic compounds, which leads to an accumulation of arsenic in the body. 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. Pdf papular palmoplantar hyperkeratosis following chronic. Histopathology of cutaneous squamous cell carcinoma brigid maguire, mbbs, frcpa, diprcpath.
Elsevier histopathology of cutaneous squamous cell carcinoma. Irritated seborrheic keratosis spongiosis epidermal intercellular edema and inflammation. 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. Three cutaneous cancers are associated with chronic exposure to arsenic. We report the case of a 61yearold woman who presented with a long history of multiple symptomatic hyperkeratotic papules on the palms and soles. Keratosis punctata palmoplantaris kppp is a rare genodermatosis with an autosomaldominant pattern of inheritance. Pearls variablehistopathology, clinical3pathologycorrelationwitharsenicexposure varyfromseborrheic keratosis3likelesionstohyperplasticactinic. Several epidemiologic studies of communities exposed to drinking water with higher arsenic levels have not shown any excess incidence of skin cancers. Histopathology of skin lesions in chronic arsenic toxicitygrading of. Arsenical keratosis is considered precancerous, since it has the potential to progress into skin cancer. Key differences identified between actinic keratosis and cutaneous squamous cell carcinoma by transcriptome profiling. Surgical interventions, oral retinoids, and nutritional buildup were done.
Chronic arsenical intoxication can still be found in environmental and industrial settings. 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. A case of arsenical keratosis followed by cancer the. Arsenic is also found to be an environmental contaminant in drinking water and an occupational hazard for miners and glass workers. Arsenicosis, arsenic ingestion, arsenic contamination, chronic. Microscopic examination histopathology of keratosis pilaris kp lesions shows the triad of epidermal hyperkeratosis, hypergranulosis, and plugging of individual hair follicles. 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. Treatment of arsenical keratosis and bowens disease with. May 02, 2018 the treatment may involve the use of topical applications, laser therapy, and surgery. Arsenical keratosis, a keratotic skin disorder caused by chronic arsenic exposure, generally presents. 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. Punctate palmoplantar keratoderma ppk inherited keratodermas have central keratotic. Arsenic also causes pigment changes and very frequently hyperkeratotic lesions of the skin called arsenical keratoses.
Clinical and histopathological investigation of seborrheic. Objectives to assess the spectrum of histopathological changes in arsenical keratoses. Hyperkeratosis wo parakeratosis so no nucleiacanthosis thickening of basal and spinosum layer. Of these, keratosis is the most common, but it is hardly seen any longer because of the greatly decreased use of arsenical derivatives. Here we report a rare case of arsenical keratosis presented with multiple polymorphic eruptions combined with chloracne. Role of linoleic acid in arsenical palmar keratosis. Often causes hyperkeratotic lesions of skin called arsenical keratoses. The earliest and most common manifestations are dermatological, and therefore, recognition of hallmark lesions is key. Histopathology of palmar keratoses associated with cancer. 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. Also called solar keratosis, senile keratosis buildup of excessive keratin due to chronic exposure to sunlight on sunexposed sites face, arms, dorsum of hands. Case report arsenical keratosis caused by medication. Arsenical keratosis secondary to fowler solution jaad.
Molecularbiological examination of a skin biopsy detected. 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. Effect of ethanol extract of leaves of azadirachta indica on palmar arsenical keratosis. 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. Arsenic keratosis in a patient from newfoundland and. Radiation exposure exposure to certain chemicals such as arsenic certain genetic conditions such as xeroderma pigmentosum and gorlin syndrome it may. 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. Marys hospital, college of medicine, the catholic university of korea, uijeongbu, korea. Aldehyde dehydrogenase 1 expression in basal cell carcinoma, actinic keratosis and bowens disease.
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. Pattern of skin bacteria in palmar arsenical keratosis. May 14, 2007 histopathology skin actinic keratosis. Jan 15, 2015 medicationinduced arsenical keratosis is a rare type of arsenical keratosis. The punctate ppks are subdivided into acquired and hereditary forms. The full text of this article is available as a pdf 242k. What are the histologic findings characteristic of keratosis. Punctate palmoplantar keratoderma ppk inherited keratodermas have central keratotic plugs that may be removed. Arsenical squamous cell carcinoma occurs less frequently than bowen disease, but it appears to be more aggressive than suninduced squamous cell carcinoma. Arsenicrelated bowens disease, palmar keratosis, and. 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.
Bowen disease is the most common form of skin cancer induced by arsenic exposure. Successful treatment of palmoplantar arsenical keratosis with a combination of keratolytics and lowdose acitretin. Many cutaneous diseases with perturbed differentiation, including arsenical keratosis, show altered patterns of integrin distribution and expression. Additionally, some may develop into invasive squamous cell carcinoma. 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. Study on the histopathology of chronic arsenicosis journal of. 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. Acquired forms include arsenical keratoses and keratosis. Treatment of arsenical keratosis and bowens disease with acitretin. Arsenic is a well water contaminant, used in industrial, mining, agricultural pesticide and medicinal chemotherapy substances toxicol sci 2011. Carcinoma, cutaneous horn, sebaceous cyst, seborrheic keratosis, squamous cell, stratum corneum access this article online. Papular palmoplantar hyperkeratosis following chronic. There is no reliable method to distinguish arsenical keratoses from actinic keratoses.
Histopathology of verrucalike eruption above the upper lip showed. May 22, 2007 histopathology skin arsenical keratosis. Lichenoid actinic keratosis has atypical hyperchromatic basal cells esp. In this video histology of arsenical keratosis is discussed. Stucco keratosis pointed papillomatous projections. Histopathological examination showed changes consistent with the diagnosis of arsenical keratosis. Treatment with oral etretinate is reported in a case of arsenical keratosis with bowens disease. The patients are being followed up every six months to monitor cancer. Only isolated incidences of cutaneous toxicity from environmental or medicinal exposure have been reported. Keratosis punctata palmoplantaris controlled with topical. In this report, we describe a suspected case of palmoplantar arsenical keratosis in a patient from newfoundland, canada. Study on the histopathology of chronic arsenicosis semantic scholar.
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