Non-healing Scalp Ulcer Accompanying Chronic Arsenicosis: A Case Report

Arsenic, an environmental toxin, significantly contributes to the development of several health problems. Epidemiological studies done across the globe have reported that a prolonged arsenic exposure has been associated with characteristic skin lesions, neuropathy and an increased risk of skin, lung, liver (angiosarcoma), bladder, kidney and colon cancers. In present study, we are reporting a case of a 60-year-old male, who presented with a large (5cm x 4cm) painless ulcer in fronto-parietal area of scalp, with occasional oozing of blood. X-ray of skull (AP and lateral view) revealed granular well-outlined osteolytic lesions in right fronto-parietal skull vault, which raised a suspicion of malignancy. An incisional biopsy was taken and histopathology revealed no evidence of malignancy. A benign, non-healing skin ulcer is rarely seen in a setting of chronic arsenicosis. His skin examination showed characteristic fine freckles of spotted pigmentary changes i.e. classic rain-drop pigmentations which were present all over the body, particularly on trunk, palms and soles. Arsenic levels seen in hair and nail of the patient were 1.23 micrograms/gram and 3.26 micrograms/gram respectively, which were in accordance with WHO suggested diagnostic criteria of chronic arsenicosis.