Department of Dermatology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Dermatology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China.
Skin Res Technol. 2024 Sep;30(9):e13903. doi: 10.1111/srt.13903.
Arsenical keratosis is a precancerous dermatosis which could be induced by long-term exposure to arsenic poisoning. Arsenic is often added to traditional Chinese medicine in a non-compliant manner to increase the effectiveness of psoriasis treatment, which is often the main cause of arsenic poisoning in Chinese patients with psoriasis.
We performed a systemic review of arsenic keratosis during the past 32 years to better understand the sources, treatment, and prognosis of arsenic keratosis in China.
We searched Medline/PubMed, Embase, CNKI, and Wanfang databases for research studies published between 1992 and 2024. A total of 64 papers with 78 individual Chinese of arsenical keratosis were included in this analysis.
Of the patients included in the analysis, 92.21% of arsenic poisoning was due to iatrogenic factors: Chinese traditional medicine. Seventy-six patients (98.70%) had skin manifestation of hyperkeratotic papules and plaques, 68 patients (88.31%) had hyperpigmentation, 43 cases (55.84%) had hypopigmentation, and only 4 had a clear indication of Mees' lines in nails. A total of 52.63% of patients presented with tumors, including squamous cell carcinoma, Bowen's disease, and basal cell carcinoma. For patients with tumors, 20 opted for surgery, 6 for radiotherapy, and 3 for PDT. All patients with only cutaneous tumors are currently well-controlled. Death occurred in one patient with metastatic squamous cell carcinoma. Keratinizing papules improved significantly in 70.59% of patients treated with Acitretin Capsules.
In this study, arsenic sources in Chinese patients were mainly from traditional Chinese medicine, and there were no reports of exposure to water sources or occupational sources in the past 32 years. Most of the patients showed keratinizing papules and pigmentation, and more than 1/2 of the patients showed skin tumors, mainly squamous cell carcinoma. The treatments of tumors are mainly surgical treatment, PDT and radiotherapy can also be selected. The improvement in keratinizing rash was greater than 70% with acitretin capsules. Patients with this disease should be regularly followed up for early detection and timely treatment of potential malignant tumors.
砷角化病是一种癌前皮肤病，可由长期暴露于砷中毒引起。砷经常以不合规的方式添加到中药中，以提高银屑病治疗的效果，这往往是中国银屑病患者砷中毒的主要原因。
我们对过去 32 年来砷角化病进行了系统回顾，以更好地了解中国砷角化病的来源、治疗和预后。
我们检索了 Medline/PubMed、Embase、CNKI 和万方数据库，以获取 1992 年至 2024 年期间发表的研究论文。共有 64 篇论文，涉及 78 例中国砷角化病患者纳入本分析。
在纳入分析的患者中，92.21%的砷中毒是由医源性因素引起的：中药。76 例（98.70%）患者有角化过度的丘疹和斑块皮肤表现，68 例（88.31%）患者有色素沉着，43 例（55.84%）患者有色素减退，只有 4 例指甲有明确的梅氏线。共有 52.63%的患者出现肿瘤，包括鳞状细胞癌、鲍文病和基底细胞癌。对于肿瘤患者，20 例选择手术治疗，6 例选择放疗，3 例选择 PDT。所有仅患有皮肤肿瘤的患者目前均得到良好控制。1 例转移性鳞状细胞癌患者死亡。阿维 A 胶囊治疗的 70.59%角化丘疹患者明显改善。
在这项研究中，中国患者的砷源主要来自中药，在过去 32 年中没有报告接触水源或职业源的情况。大多数患者表现为角化丘疹和色素沉着，超过 1/2的患者出现皮肤肿瘤，主要是鳞状细胞癌。肿瘤的治疗主要是手术治疗，也可以选择 PDT 和放疗。阿维 A 胶囊治疗角化性皮疹的改善率大于 70%。患有这种疾病的患者应定期随访，以便早期发现和及时治疗潜在的恶性肿瘤。
