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 Table of Contents  
THE CLINICAL PICTURE
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 61-62

Rain drop pigmentation in chronic arsenic poisoning


1 Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
2 Aesthetic Aura Skin & Hair Clinic, Hyderabad, Telangana, India
3 Department of Community Medicine, KPC Medical College and Hospital, Kolkata, West Bengal, India

Date of Submission27-Oct-2019
Date of Decision06-Dec-2019
Date of Acceptance25-Feb-2020
Date of Web Publication10-Jul-2020

Correspondence Address:
Dr. Anupam Das
Building “PRERANA”, 19, Phoolbagan, Kolkata 700086, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/Pigmentinternational.Pigmentinternational_

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  Abstract 


Contamination of ground water with arsenic is a problem being faced by over 30 countries in the world, since a few decades. Arsenicosis is a multisystem disorder characterised by cutaneous, gastrointestinal, urological and hematological manifestations. The WHO defines arsenicosis as a chronic health condition arising from prolonged ingestion (not less than 6 months) of arsenic above a safe dose, usually manifested by characteristic skin lesions, with or without involvement of internal organs. The WHO guideline for arsenic in drinking water is 0.01mg/ml. Cutaneous lesions are the earliest manifestations characterised by mottled pigmentation of covered areas of body called as rain drop pigmentation, blotchy mucosal pigmentation, depigmentation, palmoplantar pitting and keratosis.[1] Cutaneous malignancies which can be caused by arsenicosis include bowens disease, squamous cell carcinoma, basal cell carcinoma and melanoma.[2] It can also cause ischemic heart disease, hepatosplenomegaly, black foot disease and internal malignancies. [3]

Keywords: Arsenicosis, pigmentation, rain drop


How to cite this article:
Das A, Toshniwal A, Majumdar K. Rain drop pigmentation in chronic arsenic poisoning. Pigment Int 2020;7:61-2

How to cite this URL:
Das A, Toshniwal A, Majumdar K. Rain drop pigmentation in chronic arsenic poisoning. Pigment Int [serial online] 2020 [cited 2020 Aug 14];7:61-2. Available from: http://www.pigmentinternational.com/text.asp?2020/7/1/61/289340




  Case report Top


A 43-year old male patient hailing from Murshidabad district of West Bengal came with chief complaints of hyperpigmented and hypopigmented patches on the trunk and back since 5 years [Figure 1] and [Figure 2]. He complained of easy fatiguability and similar complaints in his other family members as well. A presumptive clinical diagnosis of chronic arsenic poisoning was made with hematological reports showing hypochromic microcytic anemia (8 mg/dl)[1],[2],[3] The other investigations were normal. Based on the endemic region, and similar features in family members and mottled pigmentation, a diagnosis of chronic arsenic poisoning was made. The patient was counselled regarding the usage of filters, carcinogenic and neuropathic complications. He has also been advised to bring his family members to our OPD for screening of manifestations of arsenicosis.
Figure 1 Hyperpigmented and hypopigmented macules scattered on the back.

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Figure 2 Hyperpigmented and hypopigmented macules on the axilla.

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Laskar M, Das A, Maiti A. Raindrop Pigmentation in Chronic Arsenic Toxicity. Am J Med Sci. 2016;351:625  Back to cited text no. 1
    
2.
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. 2
    
3.
Anupam Das, Rudrajit Paul, Nilay Kanti Das. Chronic arsenicosis: clinical features and Diagnosis. In Prof Narayan Chakraborty ed. Arsenic Toxicity: Prevention and Treatment. CRC Press, (Taylor and Francis group) pp.375-400  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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