砷所致皮肤损害的风险评估一直受到全球的重视。从饮用水中暴露的砷的理论可能不适用于燃煤型砷暴露区域。此外，很少有研究成功确定导致特定皮肤病变的累积砷(AS)暴露的参考值。本研究进行了为期22年的跟踪调查，从危险识别、剂量反应评估、暴露评估和风险表征等方面评估了长期多途径砷暴露引起的皮肤病变和癌症的风险。结果表明，砷暴露会显著增加皮肤病变的患病率。对于每个头发砷(HA)和AS累积暴露(CA)的四分位数增加，皮肤损伤的风险分别增加1.91倍和3.90倍。砷引起各种皮肤病变的HA基准剂量的下限范围为0.07至0.12μg·g-1，CA的范围为932.57至1368.92mg。在综合防治措施后，砷暴露区域的慢性日摄入量和终身平均日剂量已显著下降，但仍高于每日基准水平3.0μg·kg-1·d-1。即使到2020年，危险系数和危险指数仍超过1，分别为155.33和55.20，而皮肤癌终生超标风险(2.80×10-3)仍显著高于可接受的10-6级别。我们的研究强调了在燃煤型砷中毒区域管理高砷暴露的综合防控措施的有效性。然而，需要认识到皮肤的非致癌和致癌效应的风险仍明显高于可接受的水平。我们建议为暴露于砷中的个体设定监测皮肤损害的参考限值，HA的建议上限为0.07μg·g-1，CA的最大可接受水平为935.57mg.Copyright © 2023. Elsevier B.V. 发表。

Risk assessment of arsenic-induced skin damage has always received significant global attention. Theories derived from arsenic exposure in drinking water may not be applicable to the coal-burning type to arsenic-exposed area. Furthermore, very few studies have successfully determined the reference value of cumulative arsenic (CA) exposure that leads to specific skin lesions. In this study, we conducted a 22-year follow-up investigation to assess the risk of skin lesions and cancer resulting from long-term, multi-channel arsenic exposure from hazard identification, dose-response assessment, exposure assessment, and risk characterization. The results show that the arsenic exposure can significantly increase the prevalence of skin lesions. For each interquartile range increase of hair arsenic (HA) and CA, the risk of skin damage increased by 1.91 and 3.90 times, respectively. The lower confidence limit of the benchmark dose of HA of arsenic-induced various skin lesions ranged from 0.07 to 0.12 μg·g-1, and 932.57 to 1368.92 mg for CA. The chronic daily intake, lifetime average daily dose in the arsenic-exposed area after the comprehensive prevention and control measures have decreased significantly, but remained higher than the daily baseline level of 3.0 μg·kg-1·d-1. Even as recently as 2020, the hazard quotients and hazard index still exceeded 1, measuring 155.33 and 55.20, and the lifetime excess risk of skin cancer (2.80 × 10-3) remains significantly higher than the acceptable level of 10-6. Our study underscores the effectiveness of comprehensive prevention and control measures in managing high arsenic exposure in coal-burning arsenic poisoning areas. However, it is crucial to acknowledge that the risk of both non-carcinogenic and carcinogenic effects on the skin remains substantially higher than the acceptable level. We recommend setting reference limits for monitoring skin damage among individuals exposed to arsenic, with a recommended upper limit of 0.07 μg·g-1 for HA and a maximum acceptable level of 935.57 mg for CA.Copyright © 2023. Published by Elsevier B.V.