Arsenic reduction in drinking water and improvement in skin lesions: a follow-up study in Bangladesh.
BACKGROUND
Chronic exposure to arsenic is associated with skin lesions. However, it is not known whether reducing arsenic exposure will improve skin lesions.


OBJECTIVE
We evaluated the association between reduced arsenic exposures and skin lesion recovery over time.


METHODS
A follow-up study of 550 individuals was conducted in 2009-2011 on a baseline population of skin lesion cases (n = 900) previously enrolled in Bangladesh in 2001-2003. Arsenic in drinking water and toenails, and skin lesion status and severity were ascertained at baseline and follow-up. We used logistic regression and generalized estimating equation (GEE) models to evaluate the association between log10-transformed arsenic exposure and skin lesion persistence and severity.


RESULTS
During the study period, water arsenic concentrations decreased in this population by 41% overall, and 65 individuals who had skin lesions at baseline had no identifiable lesions at follow-up. In the adjusted models, every log10 decrease in water arsenic and toenail arsenic was associated with 22% [odds ratio (OR) = 1.22; 95% CI: 0.85, 1.78] and 4.5 times (OR = 4.49; 95% CI: 1.94, 11.1) relative increase in skin lesion recovery, respectively. In addition, lower baseline arsenic levels were significantly associated with increased odds of recovery. A log10 decrease in toenail arsenic from baseline to follow-up was also significantly associated with reduced skin lesion severity in cases over time (mean score change of -5.22 units; 95% CI: -8.61, -1.82).


CONCLUSIONS
Reducing arsenic exposure increased the odds that an individual with skin lesions would recover or show less severe lesions within 10 years. Reducing arsenic exposure must remain a public health priority in Bangladesh and in other regions affected by arsenic-contaminated water.
Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Wei Jie
WJ
Seow
Wen-Chi
WC
Pan
Molly L
ML
Kile
Andrea A
AA
Baccarelli
Quazi
Q
Quamruzzaman
Mahmuder
M
Rahman
Golam
G
Mahiuddin
Golam
G
Mostofa
Xihong
X
Lin
David C
DC
Christiani
D000328:Adult; D001151:Arsenic / Q000032:analysis / Q000633:toxicity*; D001459:Bangladesh / Q000453:epidemiology; D016022:Case-Control Studies; D060766:Drinking Water / Q000032:analysis*; D004781:Environmental Exposure; D004784:Environmental Monitoring; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D009262:Nails / Q000737:chemistry*; D012871:Skin Diseases / Q000139:chemically induced / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000633:toxicity*; D055815:Young Adult
D060766:Drinking Water; D014874:Water Pollutants, Chemical; D001151:Arsenic