title: Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence.
abstract: Skin lesions and cancer are known manifestations of chronic exposure to arsenic contaminated drinking water. Epidemiologic data primarily comes from regions with exposures 1-2 orders of magnitude above the current World Health Organization (WHO) guidelines of 10 μg/L. Emerging evidence indicates that more common exposures may also be related to both noncancerous and cancerous changes to the skin. In this review, we focus on the body of epidemiologic literature that encompasses exposures within the WHO guidelines, excluding studies that lacked individual exposure estimates and case reports. For skin lesions and skin cancers, 15 and 10 studies were identified that met our criteria, respectively. For skin lesions, a consistent dose-response relationship with water arsenic has been observed, with increased risk evident at low- to moderate-dose exposure. Of the larger studies of specific histologic types of skin cancers, although with differing exposure definitions, there was evidence of dose-related relationships with both basal cell carcinomas and squamous cell carcinomas. The effect of arsenic exposure on skin lesion risk is likely modified by genetic variants that influence arsenic metabolism. Accumulating evidence suggests that arsenic may increase risk of skin lesions and skin cancers at levels not previously considered harmful, and that genetic factors may influence risk.
authors.affiliation: Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA, Margaret.Karagas@Dartmouth.edu.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Karagas
authors.forename: Anala
authors.initials: A
authors.lastname: Gossai
authors.forename: Brandon
authors.initials: B
authors.lastname: Pierce
authors.forename: Habibul
authors.initials: H
authors.lastname: Ahsan
mesh_terms: D001151:Arsenic / Q000009:adverse effects* / Q000032:analysis; D020261:Arsenic Poisoning / Q000453:epidemiology; D002280:Basal Cell Carcinoma / Q000139:chemically induced* / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D060766:Drinking Water / Q000009:adverse effects* / Q000032:analysis; D004781:Environmental Exposure / Q000032:analysis; D014943:Global Health; D006801:Humans; D008297:Male; D012871:Skin Diseases / Q000139:chemically induced* / Q000453:epidemiology; D014877:Water Pollution, Chemical / Q000009:adverse effects* / Q000032:analysis
chemical_list: D060766:Drinking Water; D001151:Arsenic