1. WELCOME

2. Management of Arsenicosis Dr.Md.Shahidullah Sikder Haider Jahan Dr.Hasibur Rahman

3. Bangladesh Bangladesh

4. Introduction: Arsenic contamination of under groundwater has raised much concern due to its high potential to cause adverse health effects ranging from skin lesions to cancers of various organs. Arsenic contamination of under groundwater has raised much concern due to its high potential to cause adverse health effects ranging from skin lesions to cancers of various organs. There is no specific treatment available for Arsenicosis but there are some measures available for symptomatic management. There is no specific treatment available for Arsenicosis but there are some measures available for symptomatic management. It is very essential to find out an appropriate treatment regimen of Arsenicosis. It is very essential to find out an appropriate treatment regimen of Arsenicosis.

5. Subjects & Methods: 750 patients selected randomly having suspected skin lesions of Arsenicosis during the period of January 1996 to July 2005 at dermatology department of Banghabhandhu Sheikh Mujib Medical University (BSMMU),Dhaka, Bangladesh. 750 patients selected randomly having suspected skin lesions of Arsenicosis during the period of January 1996 to July 2005 at dermatology department of Banghabhandhu Sheikh Mujib Medical University (BSMMU),Dhaka, Bangladesh. Thorough clinical examination and relevant laboratory investigations were done. Thorough clinical examination and relevant laboratory investigations were done. Different modalities of treatment were applied among the different group of arsenicosis patients in different periods. Different modalities of treatment were applied among the different group of arsenicosis patients in different periods. Along with avoidance of drinking arsenic contaminated water different regimen of treatment have been applied like : (i) Topical use of salicylic acid (5% to 30%). (ii) Systemic oral use of vitamin ACE, (iii) Oral use of spirulina with other nutritional supplement (iv) Cryotherapy for hyper keratosis, (v) Combination of topical application of salicylic acid with oral vitamin & other nutritional supplement. Along with avoidance of drinking arsenic contaminated water different regimen of treatment have been applied like : (i) Topical use of salicylic acid (5% to 30%). (ii) Systemic oral use of vitamin ACE, (iii) Oral use of spirulina with other nutritional supplement (iv) Cryotherapy for hyper keratosis, (v) Combination of topical application of salicylic acid with oral vitamin & other nutritional supplement. The out come of the investigations & treatment was recorded properly. The out come of the investigations & treatment was recorded properly.

6. Rain drop Pigmentation with arsenical punctate keratosis Rain drop Pigmentation with arsenical punctate keratosis

7. Malnutrition with diffuse hyperpigmentation in chronic arsenicosis patient Malnutrition with diffuse hyperpigmentation in chronic arsenicosis patient

8. Warty Hyperkeratosis in the palm

9. Warty Hyperkeratosis & Pigmentation on the Palm & Sole

10. Unilateral leg oedema in chronic arsenicosis patient

11. Chronic liver disease in chronic arsenicosis patient

12. Bowen’s disease in chronic arsenicosis patient in the sole

13. Cutaneous malignancy in chronic arsenicosis patient

14. Result: Result:

15. Table # 01 Dermatological Manifestation: Sl.No.Presentation No. of Patients Percentage of Patients 01. Pigmentary changes Raindrop pigmentation/Diffuse pigmentation 750100% 02.HyperKeratosis i) Discrete warty lesion in palm & sole ii) Fissure/crack in Palm & Sole. iii) Diffuse Hyperkeratotic lesion in the sole & palm. 60080% 03. Palmoplanter hyperhydrosis 152% 04. Skin malignancy 152%

16. Table # 02 Systemic Manifestation: Sl.NoParameters No. of Patients Percentage of patients 01.Anaemia67590% 02.Weakness67590% 03.Anorexia67590% 04.Weightloss60080% 05. Difficulty in breathing 15020% 06. Conjunctival conjestion 9012% 07. Cramps in legs with asthenia 15020% 08. Peripheral neuropathy 233% 09.Hepatomegaly182.4% 10.Cardiomegaly91.2%

17. Table # 03 Results of topical use of Salicylic acid: Sl.No.ParameterImprovement No Change Reduced 01. Pigmentary change 10%85%5% 02.Hyperkeratosis90%5%5%

18. Table# 04 Result of oral use of Vitamin AEC( Anti-oxidant Vitamin) on the following Manifestations: Sl.No.ParameterImprovement No Change Reduced 01. Pigmentary Change 60%35%5% 02.Hyperkeratosis10%85%5% 03.Weakness80%15%5% 04.Anorexia80%15%5% 05.Anaemia70%20%10% 06.Weightloss70%20%10% 07.Breathlessness70%20%10%

19. Table # 05 Result of using spirulina & Nutritional Supplement: Sl.No.ParameterImprovement No Change Reduced 01. Pigmentary Change 70%25%5% 02.Hyperkeratosis10%85%5% 03.Weakness90%5%5% 04.Anorexia80%15%5% 05.Anaemia80%15%5% 06.Weightloss75%20%5% 07.Breathlessness75%20%5%

20. Table # 06 Result of application of Cryotherapy for Hyperkeratosis: Sl.No.ParameterImprovement No Change Reduced 01.Hyperkeratosis90%2%8%

21. Table # 07 Use of Combination therapy of Topical Salicylic acid with oral Vitamin & other nutritional supplement: Sl.No.ParameterImprovement No Change Reduced 01. Pigmentary Change 90%5%5% 02.Hyperkeratosis95%0%5% 03.Weakness90%5%5% 04.Anorexia80%15%5% 05.Anaemia80%15%5% 06.Weightloss75%20%5% 07.Breathlessness75%20%5%

22. Discussion & Conclusion: Management of arsenicosis is a complicated issue which needs options of safe drinking water, appropriate topical & systemic medication. Management of arsenicosis is a complicated issue which needs options of safe drinking water, appropriate topical & systemic medication. No single medication is available to treat a fully developed arsenicosis patient satisfactorily. No single medication is available to treat a fully developed arsenicosis patient satisfactorily. In spite of avoidance of arsenic contaminated water & treatment with available medications some patients are detoriating. In spite of avoidance of arsenic contaminated water & treatment with available medications some patients are detoriating. Early diagnosis of arsenicosis & combination therapy may save many of the victim. Early diagnosis of arsenicosis & combination therapy may save many of the victim.

23. Thank You