Arsenic-induced skin conditions identified in southwest dermatology practices: an epidemiologic tool?

Populations living in the Southwest United States are more likely to be exposed to elevated drinking water arsenic levels compared to other areas of the country. Skin changes, including hyperpigmentation and generalized hyperkeratosis, are the most common signs of chronic arsenic ingestion from drinking water. The purpose of this study was to determine the feasibility of using dermatology practices in New Mexico, Arizona, and western Texas as a surveillance system for arsenical skin disorders related to drinking water. Postcard questionnaires were mailed to practicing dermatologists. The number of cases of arsenical hyperpigmentation/keratoses seen by these dermatologists during the past 10 years and the past year were estimated. Of 240 dermatologists who were mailed questionnaires, 37 reported seeing 237 patients with arsenical hyperpigmentation/keratoses in the past 10 years and 35 patients in the past year. Since approximately one-eighth of dermatologists practicing in the Southwest saw at least one patient with arsenical hyperpigmentation/keratoses during one year, it appears feasible to complete a population-based study of these conditions.