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| THE CLINICAL PICTURE |
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| Year : 2020 | Volume
: 7
| Issue : 1 | Page : 61-62 |
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Rain drop pigmentation in chronic arsenic poisoning
Anupam Das1, Anand Toshniwal2, Kunal Majumdar3
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 Submission | 27-Oct-2019 |
| Date of Decision | 06-Dec-2019 |
| Date of Acceptance | 25-Feb-2020 |
| Date of Web Publication | 10-Jul-2020 |
Correspondence Address:
Dr. Anupam Das
Building “PRERANA”, 19, Phoolbagan, Kolkata 700086, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/Pigmentinternational.Pigmentinternational_
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 |
| Case report | |  |
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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Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Laskar M, Das A, Maiti A. Raindrop Pigmentation in Chronic Arsenic Toxicity. Am J Med Sci. 2016;351:625  |
| 2. | Sengupta SR, Das NK, Datta PK. Pathogenesis, clinical features and pathology of chronic arsenicosis. Indian J Dermatol Venereol Leprol 2008;74:559-70 |
| 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 |
[Figure 1], [Figure 2]
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