Medical Information
Arsenical Keratosis

Arsenical Keratosis

Skin Care
Diseases & Conditions
Contributed byLester Fahrner, MD+1 moreAug 29, 2022

What are the other Names for this Condition? (Also known as/Synonyms)

  • Arsenic Exposure causing Keratosis
  • Keratosis due to Arsenic Exposure

What is Arsenical Keratosis? (Definition/Background Information)

  • Prolonged exposure of the body to arsenic results in damage of the DNA, causing skin signs and symptoms. This is called Arsenical Keratosis
  • Arsenic exposure may occur through industrial exposure, ingestion of contaminated water, or through drugs and medications (typically native medicine that contain high levels of arsenic)
  • The affected regions typically include the hands and feet. Arsenical Keratosis results in the formation of numerous pigmented skin lesions; chronic exposure may cause the whole body to be affected
  • Arsenical Keratosis is considered precancerous, since it has the potential to progress into skin cancer. Hence, prompt recognition and treatment of the condition is necessary
  • The treatment may involve the use of topical applications, laser therapy, and surgery. The prognosis of Arsenical Keratosis is generally excellent with suitable early treatment

Who gets Arsenical Keratosis? (Age and Sex Distribution)

  • Arsenical Keratosis usually forms over many decades (20-30 years). Hence, they are mostly observed in adults
  • In some cases, following exposure to arsenic, the manifestation of signs and symptoms may occur within a few years (2 years or more). In such cases, both children and adults may be affected
  • No gender inequality has been observed; both males and females are equally prone to the condition
  • All racial and ethnic groups may be affected. Nevertheless, this factor varies across different geographical regions and is mostly based on occupational and environmental factors

What are the Risk Factors for Arsenical Keratosis? (Predisposing Factors)

The risk factors for Arsenical Keratosis include:

  • Individuals working in factories and industries where exposure to arsenic may occur
  • Taking certain naturopathic medications or folk medicine preparations that contain arsenic
  • Potable water that is contaminated by the presence of arsenic and arsenic compounds
  • Individuals with weak immune system, which could be due to cancer treatment, AIDS, or those on immunosuppressant drugs after receiving an organ transplant

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Arsenical Keratosis? (Etiology)

  • Arsenical Keratosis is caused when skin cells (the keratinocytes that form the epidermis) are damaged from prolonged and frequently severe exposure to arsenic or arsenic-based compounds, over many decades
  • Study research indicate that chronic exposure to arsenic and its compounds can result in genetic and chromosomal abnormalities
  • The source of arsenic may be from occupational exposure, ingestion of contaminated water, or due to native medicines containing arsenic (sometimes in high levels). This causes arsenic to accumulate in various body tissues including in the skin, hair, and nails
  • Scientific research has indicated that the human papillomavirus (HPV) along with other exposure factors may increase the chances for an individual to be affected by Arsenic Exposure causing Keratosis. Nevertheless, the reason behind how the virus is responsible for influencing the development of this condition remains unclear

What are the Signs and Symptoms of Arsenical Keratosis?

The skin signs and symptoms of Arsenical Keratosis may include:

  • Initial formation of yellow skin lesions (verrucous papules) mostly on the hands and feet
  • The size of the lesions may vary from 4 to 10 mm; multiple skin lesions are usually observed
  • The skin lesions may resemble actinic keratosis of skin, seborrheic keratosis, or other skin conditions
  • Gradually the skin condition gets rough, inflamed, and thickening occurs. The size of the patches can grow bigger
  • Pigmentary changes occur due to long-term deposition of arsenic in the skin
  • The fingertip-sized pigment changes are flat (macular) and darker than the surrounding normal skin. They are described as having a “raindrops on a dusty road” appearance
  • Itching or burning sensations may be experienced; severe discomfort, irritability of the affected skin may occur
  • Typical skin areas affected (in about 40% of the cases) include the lateral surfaces of the palms and fingers, toes and heels
  • The Arsenical Keratoses are typically easily detected on shaking hands

Chronic ingestion of arsenic and its associated compounds can result in systemic signs and symptoms, which affect the entire body.

How is Arsenical Keratosis Diagnosed?

A diagnosis of Arsenical Keratosis of Skin may involve the following tests and exams:

  • Complete physical examination and evaluation of one’s medical history
  • Examination of the skin by a dermatologist/skin specialist
  • Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
  • Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
  • Other tests and procedures may be necessary, if systemic signs and symptoms are noted
  • Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
  • A differential diagnosis to exclude various similar skin conditions may be necessary to establish a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Arsenical Keratosis?

The potential complications due to Arsenical Keratosis may include:

  • Permanent scarring may occur and cosmetic surgery may be required to restore the skin condition
  • Systemic signs and symptoms from chronic arsenic exposure may severely affect the entire body
  • The main complication arising from Arsenical Keratosis is that it could develop to form skin cancers (such as squamous cell carcinoma and basal cell carcinoma). This normally takes place if the treatment is delayed, or the condition is left untreated
  • The characteristic pattern of skin cancers in arsenic-exposed patients is multiple squamous cell carcinomas in situ, located NOT on sun exposed skin. This pattern is a sign to take a thorough history regarding arsenic exposure, and increase surveillance for the internal malignancies linked with arsenic
  • Long-term arsenic exposure is also known to result in the development of lung cancer and other cancers involving the genital or urinary system

How is Arsenical Keratosis Treated?

Commencing early treatment can help prevent a progressive deterioration of Arsenical Keratosis and avoid complications. Several management measures are available and these include:

  • Use of topical ointments, lotions, and creams. These may be antiseptic and anti-inflammatory applications
  • Chemical peeling, in which strong chemicals applied on the skin, cause it to peel and shed, giving way to formation of new skin
  • Use of photodynamic light or laser therapy: Light destroys the damaged cells after they are treated with a special medical application
  • Laser ablation: After anesthesia, a CO2 laser is used to vaporize the individual  keratoses
  • Electrodessication: After anesthesia, a low voltage low wattage electric current is used to burn off the individual keratoses
  • Cryotherapy: Controlled use of liquid nitrogen, to force spontaneous peeling and removal of skin
  • Complete removal of the affected skin with multiple punch biopsies is also curative

How can Arsenical Keratosis be Prevented?

A few methods to prevent Arsenical Keratosis include:

  • Drinking clean potable water
  • Avoiding the use of any ‘native’ or ‘folk’ medication containing arsenic, or with unknown or unstated ingredients
  • Do not burn wood treated to prevent outdoor rot, typically stained green made before the year 2000, as it may contain arsenic. Wood marketed since then is generally arsenic-free

In the case of an occupation exposure to arsenic, the following may be considered:

  • Regularly shower and change clothes after industrial work. Avoid bringing home contaminated clothes from the work site
  • Practice proper hand hygiene by washing hands with soap frequently
  • Ensure that industrial safety regulations for arsenic exposure is adhered to at workplaces
  • Use of respiratory masks, clothing to protect skin, etc. in an industrial setup

What is the Prognosis of Arsenical Keratosis? (Outcomes/Resolutions)

  • Early diagnosis, followed by a prolonged, continuous treatment of Arsenical Keratosis can result in an excellent prognosis
  • Severe skin conditions may cause permanent facial (or body) marks and pigmented scars, especially if proper treatment is not administered, or is delayed. In such cases, cosmetic surgery may be required to restore the skin
  • There is also a chance that some of the lesions may develop to form invasive skin cancers, when chronic exposure continues to exist. In such cases, the prognosis depends upon a set of several factors including the stage of the cancer and health condition of the individual

Additional and Relevant Useful Information for Arsenical Keratosis:

  • Prolonged exposure to the sun’s ultraviolet rays, results in damage of skin DNA, causing patches of rough, scaly, and thickened skin. This is called actinic keratosis of skin
  • The pesticide/rodenticide Paris Green was widely used on tobacco farms in the American Southeast to kill tobacco hornworms worms. Agricultural workers often developed Arsenical Keratoses from exposure to the pesticide
  • Arsenic compounds were injected to treat syphilis starting around 1900 and into the 1940s. Then, penicillin was found to be effective and much safer
  • A common household ant poison in the USA had arsenic as it active ingredient. It has been replaced with the much safer boric acid

Please read more on actinic keratosis of skin by visiting the following link below:


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On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team
Lester Fahrner, MD picture
Reviewed by

Lester Fahrner, MD

Chief Medical Officer, DoveMed Team


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