Arsenical keratosis, a keratotic skin disorder caused by chronic arsenic exposure, generally presents as hyperkeratosis and hyperpigmentation. Here, we report a rare case of arsenical keratosis coexisted with chloracne in a 56-year-old man who presented with generalized multiple polymorphic eruptions: poikiloderma, punctate keratosis, keratosis plaques, verrucalike rashes and nail opacity. Chloracne were simultaneously observed. To our knowledge, this is the first case showed arsenical keratosis combined with chloracne. As skin eruptions induced by pesticide exposure might present variously and are related to several types of cutaneous malignancy, clarifying exposure history and toxicants detection are necessary to avoid misdiagnosis.