Endemic Arsenicosis: A Clinical Diagnostic Manual with Photo Illustrations (Sino-English bilingual version)

This manual has been prepared to serve as a reference resource for medical officers, health workers and programme officers to use for clinical diagnosis of arsenicosis caused by chronic arsenic poisoning from drinking water or contaminated food due to coal burning. It also is intended for use in the training of medical professionals and health workers.
 
This manual is the first publication on clinical diagnosis of skin lesions of arsenicosis. Medical professionals have yet to establish a clear case definition of arsenicosis. However, a group of arsenicosis experts in the People’s Republic of China developed guidelines for clinical identification based on their decades of field experiences dealing with chronic arsenic poisoning. China’s Ministry of Health recently approved those guidelines.
 
Adopting the Chinese classification, this manual presents symptoms of skin lesions of arsenicosis, along with photos to illustrate its stage-by stage manifestation, that are based on cases in affected areas in China. Some variation of symptoms between areas does occur. For instance, ”black foot disease“ is associated with the consumption of drinking water containing high levels of arsenic and humic substances having fluorescent matter but was found only in Taiwan province in the 1950s. So far, it has not been identified in any other affected area in China (This manual does not include symptoms of black foot disease). Generally, however, skin lesions of arsenicosis in the forms of hyperkeratosis, hyper-pigmentation and hypo-pigmentation commonly are diagnosed in patients suffering from chronic arsenic poisoning due to the consumption of water, food or inhaling air containing high levels of arsenic. It is these symptoms taht are the focus of this manual.
 
For readers’ convenience, this manual has been published in separate English and Chinese versions.

Contents:

Acknowledgments
Preface

I. Endemic Chronic Arsenic Poisoning in China
1. Overview of the situation in Asia
2. Background of endemic chronic arsenic poisoning in China
3. Current situation of endemic chronic arsenic poisoning in China
4. Nature of endemic chronic arsenic pisoning in China
5. Factors effecting arsenicosis manifestation in China
6. Clinical and sub-clinical symptoms of arsenicosis patients in China
7. Long-term chronic arsenic toxicity and endemic cancer in China
8. China’s approach for prevention of endemic chronic arsenic poisoning

II. Key points of teh Chinese Guidelines for Clinical Diagnosis of Arsenicosis
1. Definition
2. Diagnostic criteria
3. Skin lesions as the major diagnosis index
4. Dermatological metamorphosis classification
5. Classification of clinical diagnosis

III. Photo Illustrations of Skin Lesions of Arsenicosis Manifestation
1. Hyperkeratosis on the palms (symptoms manifested from mild to advanced cases in adults)
2. Hyperkeratosis on the soles (symptoms manifested from mild to advanced cases in adults)
3. Coetaneous hyper-pigmentation and hypo-pigmentation on the trunk (symptoms manifested from mild to advanced cases in adults)
4. Bowen’s disease and skin cancer