Arsenicosis is a world wide health problem. it may be acute poisoning and chronic poisoning. chronic poisoning show up with rain drop pigmentation, palmoplantar hyperkeratosis, and other skin , hair, nail and systemic treatment. No specific treatment is yet established for chronic arsenic poisoning.

1. Arsenic and Arsenicosis
Dr Azmiree

3. What is arsenic?
• Arsenic is a naturally
occurring,
metalloid component of
the Earth's crust.

4. • Symbol: As
• Atomic
number: 33
• Atomic
weight: 74.92
• Specific gravity
: 5.73
• Valency: 2+,
3+, 5+

6. History of arsenic and arsenicosis
• Arsenic was known to the ancient Egyptian, Greek
and Chinese.
• The man credited for the identifying of element
mined as arsenic was Albertus Magnus, a German
alchemist.

7. • Arsenic was known as ‘the
king of poison’
• The suspected cause of
death of Napoleon
Bonaparte was chronic
arsenic poisoning.

8. • The Italian House of Borgia acquired
considerable wealth and power through their
use of arsenic-tainted wines to assassinate
influential popes and cardinals during the
15th and 16th centuries.

9. • The second Kumar
Ramendra Narayan Roy of
Bhawals was tried to be
killed by acute arsenic
posoning

10. Arsenic in cosmetic product

11. • In 1917, arsenicosis through ground water was first
identified in Cordoba of Argentina (Bell Ville
Disease).
• Arsenicosis was first reported in Chapai Nawabgonj
district in year 1993

12. Source of arsenic

13. • The concentration of arsenic may be higher in certain
geographical regions.
• This could be a result of human activity, such as
metal mining or the use of pesticides.
• Natural conditions can also lead to a higher
concentration.

14. • In human body, aresenic accumulation mainly
takes place through the intake of arsenic
• Arsenic contamination in ground water is the
outcome of many factors such as anthropogenic
activities, geochemical reactions, and biological
actions.

15. • The desorption and dissolution of arsenic from
arsenic rich rocks and minerals are the main
sources of groundwater contamination and soil
by oxidation and reduction process
• Volcanic rocks and geothermal fluids are another
major sources of arsenic

17. • Man-made sources:
– Agricultural and industrial activities
– Burning of fossil fuels
– Mining activities
– Use of arsenic as herbicides, fungicides and
pesticides

18. – Wood preservatives
– Crop dessicants
– Arsenic additives to livestocks
– Tannery
– Painting products

20. • Now arsenic in rice is a burning issue

21. • Arsenic preparations used in treatment-
– Arsenic trioxide in acute promyelocytic
leukaemia
– Homeopathic medicine
– Traditional chinese herbs
– Fowler’s solution containing potassium
arsenite
– Bell’s asthma mixture in Bronchial asthma
– Treatment of psoriasis

23. Global arsenic senerio
• Gold mining is by far the largest single source of
world anthropogenic arsenic. If all estimated gold
reserves are exploited, then gold mining will release
estimated 104 million tonnes of arsenic in the
environment
• With developing of era , industrialization, use of
pesticides it has became worldwide problem.

25. • Arsenic contamination of ground water is widespread
and there are a number of regions where arsenic
contamination of drinking-water is significant.
• It is now recognized that at least 140 million people
in 50 countries have been drinking water containing
arsenic at levels above the WHO provisional
guideline value of 10 g/L 9.

26. Arsenicosis in bangladesh

28. • Arsenicosis was first reported in Chapai Nawabgonj
district in year 1993.
• Now, it is estimated that between 35 to 77 million
Bangladeshi or 28 to 62% of the total population of
125 million are now at risk of chronic arsenic
poisoning

29. 2009

30. • Arsenic contamination has been found more
commonly in the tubewells which were
installed within the depth of 15–50 m.
• The arsenic contamination in tubewell water
of Bangladesh was thought to be in Gangetic
delta plain; later, the contamination was
detected in almost all the sedimentary areas
of Bangladesh, except in Hilly and Pleistocene
Uplands areas (Terrace Land)

33. WHO maximum permissible limits
• The WHO guideline value for arsenic in drinking
water is 0.01 mg/L and that is considered a safe
dose
• Bangladesh consider 0.05 mg/L as the maximum
permissible limit due to inadequate testing facilities
for lower concentrations

34. Presentation of arsenicosis
• Acute arsenic poisoning
• Chronic arsenicosis

35. Acute arsenic poisoning
• Projectile vomiting
• Dark or bloody stool followed
by rice watery stool
• Severe burning pain in throat
• Increase salivation and thrist
• Decreased urine
output
• Muscle cramp
• Cardiac arrhythmia
• Convulsion
• Coma
• Death

36. Chronic arsenicosis

37. • Pigmentary change:
– Diffuse hyperpigmentation localized or
generalized associated with hypopigmentation
giving an appearance of rain drop( rain drop
pigmentation)
– Localized pigmentation
– Spotty hypopigmentation

39. • Hyperkeratosis of palm and sole
– Stage 1: just palpable thickening and gritty
sensation
– Stage 2: simple hyperkeratosis and discrete
warty lesion
– Stage 3:hyperkeratosis with fissure or crack

42. • Hair changes: lusterless, dry , may falloff
• Nail changes:
– Brittle nail
– Mee’s line
– Pigmentation
– pitting

44. • Mucous membrane:
– Mucosal pigmentation (Blotchy pigmentation on
the undersurface of tongue or buccal mucosa)
– Conjunctival congestion, swelling, painful eye,
lacrimation

45. – Perforation of nasal septum
– Runny nose, crust formation
– Gum is red and soft
– Tongue is coated with white silvery fissure

46. • Dermatological malignancy and premalignamt
conditions:
– Arsenical keratosis
– Bowen’s disease
– Squamous cell carcinoma
– Basal cell carcinoma

48. • Constitutional symptom:
– Anorexia
– Weightloss
– Anaemia
– Weakness
– Asthenia

49. • Systemic manifestations:
– Gastrointestinal
• Abdominal discomfort
• Anorexia, Nausea, Vomiting
• Excess salivation
• Colicky abdominal pain
• Constipation
• Diarrhoea

50. – Respiratory:
• Dyspnoea, cough, bronchitis
• Lung fibrosis. ILD
• Emphysematous change
– Hepatic:
• Hepatomegaly
• Fatty infiltration
• Chronic liver disease

51. – Renal:
• Albuminuria,, hematuria, oliguria
• Cortical necrosis, tubular necrosis
• Nephropathy leading to CRF
• Cancer of- bladder, ureter

52. – Cardiovascular
• Arrhythmia
• Cardiomegali
• Conduction defect
• Heart failure
• Peripheral vascular disease
• Black foot disease

53. – Nervous system:
• Symmetrical distal polyneuropathy
• Peripheral neuropathy
• Confusion
• Dimentia
• Tremor delusion

54. – Reproductive:
• Still birth
• Sterility
• Adverse pregnancy outcomes
–Spontaneous abortion
–Still birth

55. – Hematologic:
• Anaemia
• Granulocytopenia
• Thrombocytopenia
• Other:
– Peripheral edema

56. • Nondermatological malignancy:
– Urinary bladder
– Lungs
– Liver
– Gastrointestinal
– prostate

59. Differential diagnosis
• Pityriasis versicolor
• Post kala azar leishmaniasis
• Xeroderma pigmentosa
• Addisons disease
• Dyschromatosis hereditaria universalis

60. Investigations
A) Routine
• Blood for complete blood count
• Blood urea, s. creatinine
• Liver function test
• Chest x ray
• Fasting blood sugar
• Urine routine examination

61. B) Specific:
• Detection of arsenic from hair, nail, urine, blood
• Skin biopsy for histopathology
C) Other investigations according to organ
involvement:
– Ultrasonography of KUB
– Ultrasonography of whole abdomen
– Color dopper study of lower limb
– ECG, echocardiography
– Serum protein

62. Management:
• Prevention :
– Stop further exposure of use of arsenic
contaminating water not only for drinking, but
also for cooking, washing of food and other
household works
– Ensure safe drinking water

65. – Eat vegetable to decrease absorption
– Eat protein rich diet to eliminate absorbed arsenic

66. • Local treatment:
– Topical keratolytics for palmoplantar
hyperkeratosis:
• Salicylic acid
• Urea
– For arsenical keratosis
• Imiqiumod
• 5 Flurouracil

67. • Nutritional supplement:
– Spirulina
– Vitamin A( retinol, beta carotene)
– Vitamin E
– Vitamin C
– Selenium
– Zinc

68. • Treatment of malignancy
– Simple Excision
– Mohs micrographic surgery
– Cryotherapy
– Electrosurgery
– For chronic case : oral retinoid

69. • Chelation therapy
• Chelation therapy for chronic arsenic toxicity is
thought to be the specific therapy for relief of
systemic clinical manifestations and reduction of
arsenic stores in the body, reducing subsequent
cancer risk.

70. • A study evaluating the efficacy of specific chelation
therapy with DMSA (dimercaptosuccinic acid) for
patients suffering from chronic arsenic toxicity has
not yielded better efficacy than control subjects
treated with placebo.

71. • But Therapy with DMPS(2,3-dimercapto-1-
propanesulfonic acid, Na salt) chelating agent for
arsenic, caused significant improvement of clinical
condition of chronic arsenicosis patients.
• However, the drug is costly, not available locally and
reports of long-term clinical trial are not available

72. Thank
you