Arsenical keratosis

Synonym(s)

None

Definition

Punctate keratoses of the palms and soles, occurring after long-term exposure to inorganic trivalent form of arsenic

Pathogenesis

Inorganic arsenic retained in the body for long periods after exposure, because of poor detoxification mechanisms; affecting many enzymes by combining with sulfhydryl groups; acting as a cancer promoter, through its action on chromosomes

Clinical manifestation

Punctate, non-tender, hard, yellowish, often symmetric, corn-like papules, mainly on the palms and soles; pressure points commonly involved; sometimes coalescing to form large, verrucous plaques

Differential diagnosis

Keratosis palmaris et plantaris; clavus; wart; nevoid basal cell carcinoma syndrome; porokeratosis; psoriasis of the palms and soles; lichen planus; Darier disease; Bazex syndrome; pityriasis rubra pilaris

Therapy

Acitretin; destructive modalities such as electrosurgery, liquid nitrogen cryotherapy, and laser vaporization