Objective To investigate The relationship between arsenic in drinking water andskin lesions in endemic arsenicosis area of Shanxi Province. Methods Acording to The National Diagnosis Standard for Endemic Arsenism WS/T211-2001,192 endemic arsenism and 117 controls were selected in Shanyin County of Shanxi provience. The concentration of arsenic in dinking water which was collected indoors was analyzed for total arsenic, using inductivity coupled plasma-mass spectrometty ( ICP-MS ). Results As concentration in drinking water was 4. 04 -720μg/L, The medium value of As in drinking water samples was 87. 75μg/L, and there were 63. 49% samples above the As level (50μg/L) of standards for drinking water quality in China. The water As concentrations was divided into three groups, ≤10μg/L, -50μg/L and >50 μg/L, as compared with arsenic level ( ≤10μg/L) in drinking water, the OR values for hyperkeratosis, hyerpigmentation, hypopigmention, total skin lesions was 1. 36,3. 99; 1.61,2. 96; 1. 74,6. 92; 3. 21,27. 04; respectively. Further, Spearman correlation test showed that the severity of skin lesions was associated with the increasing of As concentration in water. Conclusion As levels in drinking water was high in water-born endemic arsenism area of Shanxi province. Arsenic in drinking water has been considered as a risk factor of arsenic poisoning. The degree of skin lessions increased,'as the arsenic in drinking water increased.