A 35-year-old man presents with gradual onset thickening of the skin, fissuring of the palms, and hyperpigmentation with hypopigmented patches over the forearms. He drinks tube-well water from an area in West Bengal known for groundwater contamination. What is the most likely contaminant responsible?
- A Arsenic ✓
- B Fluoride
- C Nitrate
- D Mercury
Correct answer: A. Arsenic
Explanation
The triad of melanosis, keratosis (palmar/plantar hyperkeratosis), and skin thickening with classic rain-drop hypopigmentation is pathognonic of chronic arsenicism (arsenicosis). The Gangetic and Brahmaputra floodplains of West Bengal, Bihar, and Bangladesh are classic endemic zones due to arsenic-contaminated tube-well water. Fluoride causes dental and skeletal fluorosis. Nitrate causes methaemoglobinaemia. Mercury causes Minamata disease (neurological) or acrodynia, not this dermatological picture.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.