Transcript SSikder - Harvard University Department of Physics

WELCOME
Management of
Arsenicosis
Dr.Md.Shahidullah Sikder
Haider Jahan
Dr.Hasibur Rahman
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Bangladesh
Introduction:
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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.
It is very essential to find out an
appropriate treatment regimen of
Arsenicosis.
Subjects & Methods:
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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.
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.
The out come of the investigations & treatment was recorded
properly.
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Rain drop
Pigmentation
with arsenical
punctate
keratosis
•Malnutrition with
diffuse
hyperpigmentation
in chronic
arsenicosis patient
Warty Hyperkeratosis in the palm
Warty Hyperkeratosis &
Pigmentation on the Palm &
Sole
Unilateral leg oedema in chronic
arsenicosis patient
Chronic liver disease in chronic
arsenicosis patient
Bowen’s disease in chronic
arsenicosis patient
in the sole
Cutaneous malignancy in chronic
arsenicosis patient
Result:
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Table # 01
Dermatological Manifestation:
Sl.No.
Presentation
No. of
Patients
Percentage of
Patients
01.
Pigmentary changes
Raindrop pigmentation/Diffuse
pigmentation
750
100%
02.
HyperKeratosis
i)
Discrete warty lesion in
palm & sole
ii)
Fissure/crack in Palm &
Sole.
iii)
Diffuse Hyperkeratotic
lesion in the sole & palm.
600
80%
03.
Palmoplanter hyperhydrosis
15
2%
04.
Skin malignancy
15
2%
Table # 02
Systemic Manifestation:
Sl.No
Parameters
No. of Patients
Percentage of
patients
01.
Anaemia
675
90%
02.
Weakness
675
90%
03.
Anorexia
675
90%
04.
Weightloss
600
80%
05.
Difficulty in breathing
150
20%
06.
Conjunctival conjestion
90
12%
07.
Cramps in legs with
asthenia
150
20%
08.
Peripheral neuropathy
23
3%
09.
Hepatomegaly
18
2.4%
10.
Cardiomegaly
9
1.2%
Table # 03
Results of topical use of Salicylic acid:
Sl.No.
Parameter
Improvement No Change
Reduced
01.
Pigmentary
change
10%
85%
5%
02.
Hyperkeratosis 90%
5%
5%
Table# 04
Result of oral use of Vitamin AEC( Anti-oxidant Vitamin) on the
following Manifestations:
Sl.No.
Parameter
Improvement
No Change
Reduced
01.
Pigmentary
Change
60%
35%
5%
02.
Hyperkeratosis
10%
85%
5%
03.
Weakness
80%
15%
5%
04.
Anorexia
80%
15%
5%
05.
Anaemia
70%
20%
10%
06.
Weightloss
70%
20%
10%
07.
Breathlessness
70%
20%
10%
Table # 05
Result of using spirulina & Nutritional Supplement:
Sl.No.
Parameter
Improvement No Change
Reduced
01.
Pigmentary Change
70%
25%
5%
02.
Hyperkeratosis
10%
85%
5%
03.
Weakness
90%
5%
5%
04.
Anorexia
80%
15%
5%
05.
Anaemia
80%
15%
5%
06.
Weightloss
75%
20%
5%
07.
Breathlessness
75%
20%
5%
Table # 06
Result of application of Cryotherapy for
Hyperkeratosis:
Sl.No.
Parameter
Improvement
01.
Hyperkeratosis 90%
No Change
Reduced
2%
8%
Table # 07
Use of Combination therapy of Topical Salicylic acid with
oral Vitamin & other nutritional supplement:
Sl.No.
Parameter
Improvement No Change
Reduced
01.
Pigmentary Change
90%
5%
5%
02.
Hyperkeratosis
95%
0%
5%
03.
Weakness
90%
5%
5%
04.
Anorexia
80%
15%
5%
05.
Anaemia
80%
15%
5%
06.
Weightloss
75%
20%
5%
07.
Breathlessness
75%
20%
5%
Discussion
& Conclusion:
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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.
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.
Thank You