throat; fatigue; gastrointestinal symptoms; icterus
and skin erythema. As the disease progresses, further
symptoms can be found: loss of hair, fragile and pig-
mented nails, eczema, hyperkeratosis, and desquam-
ation of the skin on hands and feet. Later, severe
conjunctivitis, bronchitis, neurological symptoms,
hearing disturbances and vascular disorder can occur.
Some of the symptoms are reversible when exposure
is interrupted, but individual variability is great, and
neurological symptoms are particularly long-lasting.
0044 Exposure to arsenic has been associated for
decades not only with the development of different
types of cancer but also with noncarcinogenic
injuries, such as diabetes, peripheral neuropathy,
and cardiovascular diseases. Some results about the
biochemical mechanism of carcinogenesis induced by
arsenic were obtained in the last few years. But, there
are very few reliable data concerning the specific
mechanism(s) of arsenic action on cellular level in
context with noncarcinogenic effects. This is aston-
ishing in so far as arsenic is assumed to inhibit more
than 200 enzymes. But, direct enzyme inhibition
seems not to be the common toxic effect of arsenic.
Therapeutic Measures
0045 The most common antidote to arsenic poisoning is
2,3-dimercaptopropanol (BAL), which is a dithiol
binding one arsenic molecule with its two SH-groups.
Owing to the fact that this binding is more stable than
binding of arsenic to the SH-groups of the amino
acid residues, arsenic can be eliminiated via renal
excretion.
0046 Successful treatments with BAL have been
reported, especially in cases of dermatitis caused by
arsenic intoxication. After injection of the drug a
powerful stimulation of renal arsenic excretion is
registered during the first 3–6 days, accompanied by
an improvement of the skin lesions. A further chelat-
ing agent recommended in cases of arsenic poisoning
is d-penicillinamine. In severe cases of acute intoxica-
tion, exchange transfusion or hemodialysis may be
necessary.
Teratogenic and Mutagenic Effects
0047 Large doses of arsenic are reported to cause terato-
genic alterations in different animal species. Embry-
otoxic effects of arsenite (1–40 mmol l
1
) and arsenate
(10–400 mmol l
1
) on the development of mouse
embryos during early organogenesis have been regis-
tered in the form of growth retardation and malfor-
mations of the central nervous system and of the
extremities. Although no direct evidence exists for
embryotoxicity of arsenic in humans, it cannot be
conclusively ruled out that this toxic element may
be involved in unaccountable early abortions and
malformations claimed to be attributable to the tox-
icity of heavy metals.
0048Careful studies performed in the last decade point
to the mutagenic potency of arsenic. Induction of
chromosomal aberrations and sister chromatid ex-
changes have been described. A role of arsenic as a
potential synergist to ionizing radiation, as well as
inhibition of DNA repair by this element have been
supposed.
0049The ability of arsenic to induce gene amplification
may relate to its carcinogenic effects in humans since
amplification of oncogenes is observed in many
human tumors. (See Mutagens.)
Arsenic and Carcinogenesis
0050A number of epidemiological studies have been per-
formed to elucidate the correlation between chronic
arsenic exposure and cancer. The results are contro-
versial. (See Cancer: Epidemiology.)
0051Inorganic arsenic causes a variety of benign skin
lesions, including hyperpigmentation and hyperkera-
tosis. Some hyperkeratotic lesions and squamous
cell carcinomas-in-situ may progress to invasive car-
cinoma and metastasize. Locally invasive but non-
metastasizing basal cell carcinomas may also occur.
A dose–response relationship has been described
between medicinally administered arsenic and the
frequency of various skin lesions. Chronic intake of
arsenical preparations for psoriasis is reported to
cause malignant lesions in skin, lung, and liver.
0052A high incidence of carcinoma of the respiratory
tract was registered in several epidemiological studies
dealing with populations in areas highly polluted
with arsenic. Factory workers exposed simultan-
eously to arsenic and sulfur dioxide ran a very high
risk of developing multiple carcinoma.
0053In 1970 the occupational Safety and Health Ad-
ministration of the US government fixed the max-
imum concentration of inorganic arsenic in the air
to 10 mgm
3
for occupational exposure. On the
basis of several studies performed in factories causing
arsenic pollution, the same institution predicted that
the risk of lung carcinoma would rise exponentially
with increasing pollution.
0054During the last decade, several research groups
were engaged in clarifying the molecular basis of the
carcinogenic effect of arsenic without being able to
furnish a homogeneous interpretation.
0055It is generally recognized that arsenic is a human
carcinogen or promoter of carcinogenesis. Arsenite
acts as a comutagen by interfering with DNA repair,
although a specific DNA-repair enzyme sensitive to
arsenic has not been identified. Apparently only a
few sensitive enzymes are responsible for arsenic-
induced cellular toxicity. Thus, arsenic-induced
ARSENIC/Requirements and Toxicology 315