Arsenic intoxication T57.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Arsenic skin; Fowler's solution

Definition
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Diseases caused by usually long-term intake of low doses of arsenic, more rarely acute symptoms of poisoning.

Etiopathogenesis
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Complex oncogenic action of inorganic arsenic: inhibition of deoxyribonuclease, DNA and RNA polymerase. Numerous other enzymes are blocked by the reaction of arsenic with sulfhydryl groups, e.g. hexokinase, glucose-6-phosphate dehydrogenase, keto acid oxidase.

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Dermatology

Granuloma anulare erythematous

Special form of the granuloma anulare: blue-red to brown-red, extensive (up to palm size), border-emphasize...

Manifestation
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Particularly occurring in patients who were already treated decades ago for psoriasis vulgaris or anaemia (e.g. with Fowler's solution; use until 1966), who came into contact with arsenic-containing pesticides in wineries (viticulture; wineries, especially in the region of the Middle Moselle and Kaiserstuhl; pesticides containing arsenic were permitted until 1942) or in workers in copper mining and non-ferrous metal smelting. Damage caused by arsenic compounds is assessed and compensated according to BK 1108.

Clinical features
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Chronic arsenic ingestion leads to arsenic keratosis, arsenic melanosis, skin atrophies, especially on the feet and lower legs, skin vulnerability, multiple superficial basal cell carcinomas of the trunk, Bowen's disease, especially in unexposed areas of the skin, Meese's cross bands of the nails. Highly increased incidence of internal malignancies, especially of the lungs, oral mucosa and esophagus, urogenital tract, liver. Occurrence after a latency period of 10-30 years. Often multiple neoplasias. In acute intoxication abdominal cramps, vomiting, diarrhoea, headaches, paralysis, circulatory weakness dominate.

Diagnosis
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Subtle tumor screening.

Therapy
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Acute and chronic intoxication: Treatment with Dimercaprol (DMPS) (e.g. Dimaval) according to technical information.

Acute poisoning: 12-24 Kps Dimaval in 12 ED p.o.
Chronic poisoning: 3-4 Kps. Dimaval in 2-3 ED daily, in case of severe poisoning higher dosage if necessary.

Symptomatic therapy of electrolyte shifts, intensive medical care Chronic arsenic damage: Regular monitoring and treatment of skin tumours and tumours of the internal organs. Otherwise symptomatic according to the clinic.

Literature
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Bauer A (2016) Skin cancer as an occupational disease. dermatologist 67: 884-890
Grobe JW (1992) Arsenic intoxication late sequelae in Moselle vintners. Close to the skin 92: 378-387
Guo HR (2003) The lack of a specific association between arsenic in drinking water and hepatocellular carcinoma. J Hepatol 39: 383-388
Ratnaike RN (2003) Acute and chronic arsenic toxicity. Postgrade Med J 79: 391-396