Arsenic species in drinking water, hair, fingernails, and urine of patients with blackfoot disease.

A large number of residents on the southwest coast of Taiwan suffer from an endemic peripheral vascular disease called blackfoot disease. Although the etiology has been investigated since 1958, the cause of blackfoot disease remains unknown. Certain substances contained in artesian well water have been implicated as causal factors, including arsenic as the predominant element. Data in this study demonstrated that in the well water collected from blackfoot disease regions of Taiwan there was a marked increase in total arsenic concentrations, with the predominant species being inorganic arsenical compounds. The concentrations of organic methyl arsenicals were present in minimal amounts. The excretion of total arsenic, inorganic arsenic, monomethylarsonic acid, and trimethylarsenic acid in the urine of patients afflicted with blackfoot disease was significantly higher than for control subjects. Further, in patients with blackfoot disease the concentrations of total arsenic and inorganic arsenic were markedly elevated in the hair and fingernails. Data suggest that blackfoot disease is associated with individuals ingesting well, water contaminated with arsenic primarily in the inorganic form and that hair, fingernails, or urine specimens serve as equally effective biomarkers of exposure. The fact that arsenic intoxication as manifested by blackfoot disease is still prevalent despite the stoppage of well-water consumption for two decades illustrates the persistent nature of arsenic action.