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LETTER TO EDITOR
Year : 2018  |  Volume : 45  |  Issue : 1  |  Page : 47-48

A case of chronic arsenicosis from Bangladesh


Department of Medicine, Chattagram Maa-O-Shishu Hospital Medical College, Agrabad, Chittagong, Bangladesh

Date of Web Publication27-Jul-2018

Correspondence Address:
Rajat Sanker Roy Biswas
Department of Medicine, Chattagram Maa-O-Shishu Hospital Medical College, Agrabad, Chittagong
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_11_18

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How to cite this article:
Roy Biswas RS. A case of chronic arsenicosis from Bangladesh. J Sci Soc 2018;45:47-8

How to cite this URL:
Roy Biswas RS. A case of chronic arsenicosis from Bangladesh. J Sci Soc [serial online] 2018 [cited 2018 Dec 13];45:47-8. Available from: http://www.jscisociety.com/text.asp?2018/45/1/47/237752



Sir,

Chronic arsenic intoxication from drinking water contaminated from geological sources has caused a devastating health crisis in Bangladesh and also in other countries of the world.[1],[2] The total area of Bangladesh is 147,570 km2, and the population is about 160 millions.[3] In Bangladesh, arsenic contamination of water in tube wells was confirmed at first in 1993 in Chapainababgonj. Further testing was done in the following years by different agencies and institutions such as the Bangladesh Atomic Energy Commission, the Department of Public Health Engineering Laboratories, and the National Institute of Preventive and Social Medicine in Dhaka.[1] Sixty-two districts of Bangladesh have arsenic levels in groundwater above the World Health Organization maximum permissible limit of 50 μg/L.[3]

This 35-year-old normotensive male living in a rural area of the Southern part of Bangladesh presented with gradual development of hyperkeratotic pigmentary lesions on his palms with soles for the past 1 year [Figure 1]. He also noticed some hyperpigmentary lesion all over the trunk for the same duration [Figure 2]. Initially, he visited a local doctor who referred him to a dermatologist who diagnosed him as a case of chronic arsenicosis with palmoplantar hyperkeratosis with raindrop pigmentations of the trunk. All other laboratory investigations were done, and arsenic level of blood was not done. He was immediately asked not to drink water from his tube well. Water from his tube well from where they drink later was analyzed for arsenic level where it was found above the danger level (540 μg/L). He also noticed that his wife had some raindrop like pigmentations over his whole back and front of the chest. He told that they have been drinking water from the same tube well for the past 10–12 years. Chronic arsenicosis from drinking groundwater is common in this part of Bangladesh.
Figure 1: Hyperkeratosis and hyperpigmentations

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Figure 2: Rain drop pigmentations

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The health impact of exposure to arsenic depends on the dose, modality, and duration of exposure as well as source and types of arsenic. Prolong exposure to nonlethal dose of 0.005–0.09 mg/kg bodyweight/day results in arsenicosis, a disease that is characterized by dermatological features of pigmentation and keratosis. Arsenicosis also called arsenicism and is also referred to as black foot disease, black skin fever, etc., in various parts of the world. Cancers of lungs, bladder, kidney, and skin have been consistently observed in subjects drinking arsenic- contaminated water. At present, in conclusive evidence exists for linking arsenic to cardiovascular disease, diabetes or negative reproductive health outcome.[4],[5]

Pigmentation and keratosis are the specific skin lesions in chronic arsenicosis. The pigmentation commonly appears as diffuse hyperpigmentation/melanosis most intense on the trunk and extremities which are bilaterally symmetrical or localized or patchy pigmentation particularly affecting skin folds. Fine freckles of spotted pigmentary changes are also seen known as raindrop pigmentation. Sometimes, macular areas of depigmentation may appear on normal skin or hyperpigmented background producing the distinctive appearance of leukomelanosis. Blotchy pigmentation may also involve mucous membrane such as undersurface of tongue or buccal mucosa.

Arsenical hyperkeratosis appears as diffuse thickening involving palms and soles alone or in combination with nodules usually symmetrically disturbed. Keratosis on the palm or sole is the most sensitive marker for detection of arsenicosis of an early stage. Keratosis is graded as mild, moderate or severe depending on the extent and severity. The mild form appears as slight thickening or minute papules (<2 mm) in the palm and soles often associated with a indurated grit like texture which may be primarily detected by palpation. In the moderate variety, the lesions usually advance to form raised, punctuate, wart-like keratosis >2.5 mm in size that are readily visible. In severe variety keratotic elevations >5 mm in size and sometimes become confluent and diffuse and sometimes result in cracks and fissures. Histological examinations of lesions revealed hyperkeratosis, acanthosis, and enlargement of the rete ridges. In some cases, there might be evidence of cellular atypia, mitotic figure, and large vacculated epidermal cells.[5],[6],[7],[8]

So to avoid chronic arsenic exposure-related complication, there should be national plan to supply arsenic-free pure drinking water.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Milton AH, Hassan Z, Rahaman A, Rahaman M. Chronic arsenic poisoning and respiratory effects in Bangladesh. J Occup Health 2001;43:136-40.  Back to cited text no. 1
    
2.
Tseng CH, Chong CK, Tseng CP, Hsueh YM, Chiou HY, Tseng CC, et al. Long-term arsenic exposure and ischemic heart disease in arseniasis-hyperendemic villages in Taiwan. Toxicol Lett 2003;137:15-21.  Back to cited text no. 2
    
3.
Alam M, Singh SK, Hazari, Alam AS. Prevalence of skin cancer in chronic arsenicosis in Chittagong medical college hospital. J Chittagong Med Coll Teach Assoc 2010;21:23-9.  Back to cited text no. 3
    
4.
Caussy D. A Field Guide for Detection, Managment and Survilence of Arsenicosis Cases. New Delhi: World Health Organization; 2005.  Back to cited text no. 4
    
5.
Guha Mazumder DN. Chronic arsenic toxicity & human health. Indian J Med Res 2008;128:436-47.  Back to cited text no. 5
    
6.
Saha JC, Dikshit AK, Bandyopadhyay M, Saha KC. A Review of Arsenic Poisoning and its Effects on Human Health, Critical Reviews in Environmental Science and Technology, 2010;29:281-313.  Back to cited text no. 6
    
7.
Sengupta SR, Das NK, Datta PK. Pathogenesis, clinical features and pathology of chronic arsenicosis. Indian J Dermatol Venereol Leprol 2008;74:559-70.  Back to cited text no. 7
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8.
Guha Mazumder DN, Haque R, Ghosh N, De BK, Santra A, Chakraborty D, et al. Arsenic levels in drinking water and the prevalence of skin lesions in West Bengal, India. Int J Epidemiol 1998;27:871-7.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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