Speckled Pigmentation and Palmoplantar Keratoses Leading to the Mass Detection of Chronic Arsenic Poisoning

Sheena Maureen T. Sy,1 Charissa Mia Salud-Gnilo1 and Ella Joy Nogas-Perez2

1Section of Dermatology, Department of Medicine,
University of the Philippines- Philippine General Hospital
2Clinical Toxicology, Philippine General Hospital

Arsenic is a known human carcinogen and skin manifestations are the earliest and most specific markers of chronic arsenic poisoning. A 43-year-old man from Luzon presented at the Section of Dermatology with a one-year history of hyperkeratotic papules and plaques on the palms and soles. Numerous round hypopigmented macules were scattered on the upper back. Initial 24-hour urine arsenic level was elevated at 288mcg/liter. The patient underwent successful chelation with N-acetylpenicillamine and the palmoplantar keratoses were treated with cryotherapy and topical 20% salicylic acid in white petrolatum. In cooperation with the Department of Health, a comprehensive health and environmental assessment was conducted in the affected communities. This case highlights the role of dermatologists in the diagnosis and management of this public health problem.

Key Words: arsenic poisoning, Philippines, palmoplantar keratoderma, hyperkeratotic papules, chelation