An introspection into the cutaneous manifestations of chronic arsenicosis as reported in a tertiary care centre in Kolkata

Objective: To study different patterns of skin manifestations of arsenicosis. Methods: A cross-sectional observational study was done on 110 patients of clinically suspected arsenicosis attending the dermatology outdoor of a tertiary care centre in eastern India over a period of one year. Cutaneous indicators like keratosis over palms and soles, melanosis and hypopigmentation over trunk in patients coming from endemic zones were included. Arsenic level estimation was done in drinking water, hair and nails. Systemic evaluation was done in symptomatic cases. Results: Majority of the patients hailed from Nadia, North 24 Parganas and Murshidabad districts. Males and females presented equally. Skin pigmentation was present in almost all patients (95%). Raindrop pigmentation was the commonest cutaneous manifestation (71%) followed by punctuate palmar keratosis (49%). Bowen’s disease was found in 21% patients whereas squamous cell carcinoma was the commonest cutaneous malignancy (5%). Raindrop pigmentation was found more in males than females. Peak incidence was found in patients exposed to arsenic containing drinking water for a minimum of 5 years. There was strong correlation of severity of skin manifestations and level of arsenic in drinking water. Conclusion: The most common presentation of arsenicosis was raindrop pigmentation and it was found more in males. The incidence of cutaneous malignancy was 3% with premalignant Bowen’s disease being quite high (21%).