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Management of Management of ArsenicosisArsenicosis

Dr.Md.Shahidullah SikderDr.Md.Shahidullah Sikder

Haider JahanHaider Jahan

Dr.Hasibur RahmanDr.Hasibur Rahman

BangladeshBangladesh

Introduction:Introduction: Arsenic contamination of under Arsenic contamination of under

groundwater has raised much concern groundwater has raised much concern due to its high potential to cause due to its high potential to cause adverse health effects ranging from adverse health effects ranging from skin lesions to cancers of various skin lesions to cancers of various organs.organs.

There is no specific treatment There is no specific treatment available for Arsenicosis but there are available for Arsenicosis but there are some measures available for some measures available for symptomatic management.symptomatic management.

It is very essential to find out an It is very essential to find out an appropriate treatment regimen of appropriate treatment regimen of Arsenicosis. Arsenicosis.

Subjects & Methods:Subjects & Methods: 750 patients selected randomly having suspected skin lesions of 750 patients selected randomly having suspected skin lesions of

Arsenicosis during the period of January 1996 to July 2005 at Arsenicosis during the period of January 1996 to July 2005 at dermatology department of Banghabhandhu Sheikh Mujib Medical dermatology department of Banghabhandhu Sheikh Mujib Medical University (BSMMU),Dhaka, Bangladesh.University (BSMMU),Dhaka, Bangladesh.

Thorough clinical examination and relevant laboratory Thorough clinical examination and relevant laboratory investigations were done.investigations were done.

Different modalities of treatment were applied among the different Different modalities of treatment were applied among the different group of arsenicosis patients in different periods.group of arsenicosis patients in different periods.

Along with avoidance of drinking arsenic contaminated water Along with avoidance of drinking arsenic contaminated water different regimen of treatment have been applied like : (i) Topical different regimen of treatment have been applied like : (i) Topical use of salicylic acid (5% to 30%). (ii) Systemic oral use of vitamin use of salicylic acid (5% to 30%). (ii) Systemic oral use of vitamin ACE, (iii) Oral use of spirulina with other nutritional supplement ACE, (iii) Oral use of spirulina with other nutritional supplement (iv) Cryotherapy for hyper keratosis, (v) Combination of topical (iv) Cryotherapy for hyper keratosis, (v) Combination of topical application of salicylic acid with oral vitamin & other nutritional application of salicylic acid with oral vitamin & other nutritional supplement.supplement.

The out come of the investigations & treatment was recorded The out come of the investigations & treatment was recorded properly. properly.

Rain drop Rain drop Pigmentation Pigmentation with arsenical with arsenical punctate punctate keratosiskeratosis

•Malnutrition with Malnutrition with diffuse diffuse hyperpigmentation hyperpigmentation in chronic in chronic arsenicosis patientarsenicosis patient

Warty Hyperkeratosis in the palmWarty Hyperkeratosis in the palm

Warty Hyperkeratosis & Warty Hyperkeratosis & Pigmentation on the Palm & Pigmentation on the Palm &

SoleSole

Unilateral leg oedema in chronic Unilateral leg oedema in chronic arsenicosis patientarsenicosis patient

Chronic liver disease in chronic Chronic liver disease in chronic arsenicosis patientarsenicosis patient

Bowen’s disease in chronic Bowen’s disease in chronic arsenicosis patientarsenicosis patient

in the solein the sole

Cutaneous malignancy in chronic Cutaneous malignancy in chronic arsenicosis patientarsenicosis patient

Result:Result:

Table # 01Table # 01Dermatological Manifestation:Dermatological Manifestation:

Sl.No.Sl.No. PresentationPresentation No. of No. of PatientsPatients

Percentage of Percentage of PatientsPatients

01.01. Pigmentary changesPigmentary changes

Raindrop pigmentation/Diffuse Raindrop pigmentation/Diffuse pigmentationpigmentation

750750 100%100%

02.02. HyperKeratosisHyperKeratosis

i) Discrete warty lesion in i) Discrete warty lesion in palm & solepalm & sole

ii) Fissure/crack in Palm & ii) Fissure/crack in Palm & Sole.Sole.

iii) Diffuse Hyperkeratotic iii) Diffuse Hyperkeratotic lesion in the sole & palm.lesion in the sole & palm.

600600 80%80%

03.03. Palmoplanter hyperhydrosisPalmoplanter hyperhydrosis 1515 2%2%

04.04. Skin malignancySkin malignancy 1515 2%2%

Table # 02Table # 02Systemic Manifestation:Systemic Manifestation:

Sl.NoSl.No ParametersParameters No. of PatientsNo. of Patients Percentage of Percentage of patientspatients

01.01. AnaemiaAnaemia 675675 90%90%

02.02. WeaknessWeakness 675675 90%90%

03. 03. AnorexiaAnorexia 675675 90%90%

04.04. WeightlossWeightloss 600600 80%80%

05.05. Difficulty in breathingDifficulty in breathing 150150 20%20%

06.06. Conjunctival conjestionConjunctival conjestion 9090 12%12%

07.07. Cramps in legs with Cramps in legs with astheniaasthenia

150150 20%20%

08.08. Peripheral neuropathyPeripheral neuropathy 2323 3%3%

09.09. HepatomegalyHepatomegaly 1818 2.4%2.4%

10.10. CardiomegalyCardiomegaly 99 1.2%1.2%

Table # 03Table # 03

Results of topical use of Salicylic acid:Results of topical use of Salicylic acid:

Sl.No.Sl.No. ParameterParameter ImprovementImprovement No ChangeNo Change ReducedReduced

01.01. Pigmentary Pigmentary changechange

10%10% 85%85% 5%5%

02.02. HyperkeratosiHyperkeratosiss

90%90% 5%5% 5%5%

Table# 04Table# 04Result of oral use of Vitamin AEC( Anti-oxidant Vitamin) on the Result of oral use of Vitamin AEC( Anti-oxidant Vitamin) on the

following Manifestations:following Manifestations:

Sl.No.Sl.No. ParameterParameter ImprovementImprovement No ChangeNo Change ReducedReduced

01.01. Pigmentary Pigmentary ChangeChange

60%60% 35%35% 5%5%

02.02. Hyperkeratosis Hyperkeratosis 10%10% 85%85% 5%5%

03.03. WeaknessWeakness 80%80% 15%15% 5%5%

04.04. AnorexiaAnorexia 80%80% 15%15% 5%5%

05.05. AnaemiaAnaemia 70%70% 20%20% 10%10%

06.06. WeightlossWeightloss 70%70% 20%20% 10%10%

07.07. BreathlessnessBreathlessness 70%70% 20%20% 10%10%

Table # 05Table # 05Result of using spirulina & Nutritional Supplement:Result of using spirulina & Nutritional Supplement:

Sl.No.Sl.No. ParameterParameter ImprovementImprovement No ChangeNo Change ReducedReduced

01.01. Pigmentary ChangePigmentary Change 70%70% 25%25% 5%5%

02.02. Hyperkeratosis Hyperkeratosis 10%10% 85%85% 5%5%

03.03. WeaknessWeakness 90%90% 5%5% 5%5%

04.04. AnorexiaAnorexia 80%80% 15%15% 5%5%

05.05. AnaemiaAnaemia 80%80% 15%15% 5%5%

06.06. WeightlossWeightloss 75%75% 20%20% 5%5%

07.07. BreathlessnessBreathlessness 75%75% 20%20% 5%5%

Table # 06Table # 06Result of application of Cryotherapy for Result of application of Cryotherapy for

Hyperkeratosis:Hyperkeratosis:

Sl.No.Sl.No. ParameterParameter ImprovementImprovement No ChangeNo Change ReducedReduced

01.01. HyperkeratosiHyperkeratosis s

90%90% 2%2% 8%8%

Table # 07Table # 07Use of Combination therapy of Topical Salicylic acid with Use of Combination therapy of Topical Salicylic acid with

oral Vitamin & other nutritional supplement:oral Vitamin & other nutritional supplement:

Sl.No.Sl.No. ParameterParameter ImprovementImprovement No ChangeNo Change ReducedReduced

01.01. Pigmentary ChangePigmentary Change 90%90% 5%5% 5%5%

02.02. Hyperkeratosis Hyperkeratosis 95%95% 0%0% 5%5%

03.03. WeaknessWeakness 90%90% 5%5% 5%5%

04.04. AnorexiaAnorexia 80%80% 15%15% 5%5%

05.05. AnaemiaAnaemia 80%80% 15%15% 5%5%

06.06. WeightlossWeightloss 75%75% 20%20% 5%5%

07.07. BreathlessnessBreathlessness 75%75% 20%20% 5%5%

Discussion Discussion & Conclusion:& Conclusion:

Management of arsenicosis is a complicated issue Management of arsenicosis is a complicated issue which needs options of safe drinking water, which needs options of safe drinking water, appropriate topical & systemic medication.appropriate topical & systemic medication.

No single medication is available to treat a fully No single medication is available to treat a fully developed arsenicosis patient satisfactorily.developed arsenicosis patient satisfactorily.

In spite of avoidance of arsenic contaminated water In spite of avoidance of arsenic contaminated water & treatment with available medications some & treatment with available medications some patients are detoriating.patients are detoriating.

Early diagnosis of arsenicosis & combination Early diagnosis of arsenicosis & combination therapy may save many of the victim. therapy may save many of the victim.

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