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CORRESPONDENCE
Year : 2018  |  Volume : 63  |  Issue : 5  |  Page : 430-431
Familiar manifestations of unfamiliar selenium toxicity


1 Dr. Banashree Skin and Cosmetic Centre, Jaipur, Rajasthan, India
2 Department of Dermatology, Chirayu Hospital, Jaipur, Rajasthan, India
3 Panchudala Primary Health Centre, Jaipur, Rajasthan, India
4 Kaya Skin Clinic, Jaipur, Rajasthan, India

Date of Web Publication31-Aug-2018

Correspondence Address:
Banashree Majumdar
Dr. Banashree Skin and Cosmetic Centre, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_455_17

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How to cite this article:
Majumdar B, Saini N, Agrawal S, Prakash C. Familiar manifestations of unfamiliar selenium toxicity. Indian J Dermatol 2018;63:430-1

How to cite this URL:
Majumdar B, Saini N, Agrawal S, Prakash C. Familiar manifestations of unfamiliar selenium toxicity. Indian J Dermatol [serial online] 2018 [cited 2020 Sep 25];63:430-1. Available from: http://www.e-ijd.org/text.asp?2018/63/5/430/240107




Sir,

Selenium is an essential, trace, and unusual metalloid as it both induces and cures cancer. It is of fundamental importance to human health. It is best known as an antioxidant and as catalyst which is needed for the proper functioning of the immune system.[1] Excess can lead to cytotoxicity and genotoxicity mainly by modifying thioredoxin reductase.[2] The most common sign of the poisoning is the loss of hair and nails although lesions of the skin, nervous system, and possibly teeth may be present.[3]

Recently, we dealt with a case hailing from a village near Jaipur, a 35-year-old lady presenting with nonscarring alopecia [Figure 1] along with nail changes such as clubbing, onychomadesis, onycholysis, nail bed erythema, and pustule formation [Figure 2]. Type of hair loss was similar to anagen effluvium. Detailed history of the patient revealed prior appearance of generalized skin eruption a few months back, details of which were absent. Systemic manifestations were weakness, fatigue, and headache, along with pain in flank region and increased frequency of micturition. Total duration of illness was around 3 weeks. We tried to fetch enough clues as it was difficult to assign a particular diagnosis to this case. Further history revealed the presence of similar symptoms not only in other members of her family but also in many of the co-villagers, even the village animals were showing some vague symptoms such as decreased intake of food and drinks along with reduced milk output. Failing to arrive at any appropriate diagnosis, the patient was asked to report with other members of his family. History and physical examination findings were similar except a very significant association being absence of disease manifestation in household with government pipeline water supply in contrast to those using underground boring water. Hence, the chances of it related to water source were strong, but the hint was still vague enough to arrive at any diagnosis. The patient was asked to come back with a sample of boring water they were using at that time.
Figure 1: Nonscarring alopecia over scalp

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Figure 2: Clubbing, onychomadesis, onycholysis, nail bed erythema, and granulation involving majority of nails

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Meanwhile, a thorough literature review of chemical contamination from industries or heavy metal contamination, selenium toxicity seemed a relevant differential by the exclusion of others.

During the next visit, we took patients serum sample along with the water sample. Only serum sample was sent to a private equipped laboratory as they refused to evaluate water sample. Result received after 7 days uncovered above 500 μg/L as the observed value of selenium in the serum sample in contrast to the normal individual range of 74–90 μg/L. Water samples were taken by the Public Works Department which they confirmed of having excess selenium in five out of eight samples, but due to some issues beyond our reach, level of selenium in the samples was not disclosed to us. KOH mount of hair and nail clippings did not reveal any fungal elements; the fungal culture was negative.

A very similar observation was made by Agarwal et al. from Rajasthan region itself except the culprit agent leading to selenium toxicity was found to be edible wheat sources, whereas in our case more than permissible level of selenium in water was responsible for the disease manifestations.[4]

Hence, although a rare entity, selenium toxicity still continues to be a significant scourge keeping in view the morbidity it leads to and hence we should consider it as a rare differential in patients presenting with alopecia and nail changes.

Acknowledgment

We would like to acknowledge the support of Dr. Soumyodhriti Ghosh and Dr. Tarachand Saini.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Rayman MP. The importance of selenium to human health. Lancet 2000;356:233-41.  Back to cited text no. 1
    
2.
Sun HJ, Rathinasabapathi B, Wu B, Luo J, Pu LP, Ma LQ, et al. Arsenic and selenium toxicity and their interactive effects in humans. Environ Int 2014;69:148-58.  Back to cited text no. 2
    
3.
Yang GQ, Wang SZ, Zhou RH, Sun SZ. Endemic selenium intoxication of humans in China. Am J Clin Nutr 1983;37:872-81.  Back to cited text no. 3
    
4.
Agarwal P, Sharma S, Agarwal US. Selenium toxicity: A rare diagnosis. Indian J Dermatol Venereol Leprol 2016;82:690-3.  Back to cited text no. 4
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