Mercury-containing Skin-lightening Creams Research Articles

Nephrotic syndrome of minimal change disease following exposure to mercury-containing skin lightening cream: A case report and literature review

Long-term exposure to mercury-containing skin lightening cream can cause mercury-related nephropathy, among which, membranous nephropathy (MN) and minimal change disease (MCD) are the main pathological types. In contrast to these two conditions, MCD with IgA deposition is not a common disease. In the present study, we report a 65-year-old Asian woman who developed nephrotic syndrome following long-term use of mercury-containing skin lightening cream. The urine mercury level of the patient was significantly increased, and the results of the renal biopsy indicated diagnosis of MCD with IgA deposition. Following three courses of treatment with sodium dimercaptopropane sulfonate (DMPS) alone and discontinuation of the skin cream, the symptoms of the patient were relieved without use of glucocorticoids, with proteinuria turning negative and a significant reduction in urine mercury levels. During the 6-month follow-up period, routine urinalysis remained normal. By reviewing relevant published literature, we summarized the pathological characteristics, possible mechanism of action, and treatment strategies of mercury poisoning-related MCD. The possibility of mercury poisoning should be considered for patients with nephropathy and history of use of skin lightening cosmetics. In these patients, the urine mercury levels should be measured in time so that mercury removal therapy can be implemented early.

Tracking Declines in Mercury Exposure in the New York City Adult Population, 2004\u20132014

Mercury is a toxic metal that can be measured in human blood and urine. Population-based biomonitoring from 2004 guided New York City (NYC) Department of Health and Mental Hygiene (DOHMH) efforts to reduce exposures by educating the public about risks and benefits of fish consumption—a predominant source of exposure in the general population—and removing mercury-containing skin-lightening creams and other consumer products from the marketplace. We describe changes in exposures over the past decade in relation to these local public health actions and in the context of national changes by comparing mercury concentrations measured in blood (1201 specimens) and urine (1408 specimens) from the NYC Health and Nutrition Examination Survey (NYC HANES) 2013–2014 with measurements from NYC HANES 2004 and National Health and Nutrition Examination Surveys (NHANES) 2003–2004 and 2013–2014. We found that NYC adult blood and urine geometric mean mercury concentrations decreased 46% and 45%, respectively. Adult New Yorkers with blood mercury concentration ≥ 5 μg/L (the New York State reportable level) declined from 24.8% (95% CL = 22.2%, 27.7%) to 12.0% (95% CL = 10.1%, 14.3%). The decline in blood mercury in NYC was greater than the national decline, while the decline in urine mercury was similar. As in 2004, Asian New Yorkers had higher blood mercury concentrations than other racial/ethnic groups. Foreign-born adults of East or Southeast Asian origin had the highest prevalence of reportable levels (29.7%; 95% CL = 21.0%, 40.1%) across sociodemographic groups, and Asians generally were the most frequent fish consumers, eating on average 11 fish meals in the past month compared with 7 among other groups (p < 0.001). Fish consumption patterns were similar over time, and fish continues to be consumed more frequently in NYC than nationwide (24.7% of NYC adults ate fish ten or more times in the past 30 days vs. 14.7% nationally, p < 0.001). The findings are consistent with the hypothesis that blood mercury levels have declined in part because of local and national efforts to promote consumption of lower mercury fish. Local NYC efforts may have accelerated the reduction in exposure. Having “silver-colored fillings” on five or more teeth was associated with the highest 95th percentile for urine mercury (4.06 μg/L; 95% CL = 3.1, 5.9). An estimated 5.5% of the adult population (95% CL = 4.3%, 7.0%) reported using a skin-lightening cream in the past 30 days, but there was little evidence that use was associated with elevated urine mercury in 2013–14.

Additional comments to "Potential health consequences of applying mercury-containing skin-lightening creams during pregnancy and lactation periods".

Exposure through human skin from application of skin lightening creams and soaps (SLCS) based on mercury salts has often escaped attention of environmental scientists. The skin absorption of Hg from an adult on a daily basis in this type of exposure, depending on the product used, can be higher than Hg originated from dental amalgam filling, Thimerosal-containing flu vaccine, and fish-methylmercury. Hg from SLCS is retained more in brain of albino than pigmented animals. Therefore, environmental Hg scientists should be aware of this important but often neglected source of low-dose Hg exposure during pregnancy and lactation when measuring adverse health effects on child growth and development.

Potential health consequences of applying mercury-containing skin-lightening creams during pregnancy and lactation periods.

Many studies have highlighted the widespread use of skin-lightening creams containing mercury by women during and after pregnancy to remove dark spots. Women, especially pregnant and lactating mothers using these products are at risk of mercury poisoning because sometimes it has no clinical symptoms, particularly during early exposure. Studies have shown that prenatal and postnatal mercury exposure can cause permanent neurological damage in children. Furthermore, mercury can cause women infertility and birth defects. Even though several studies have examined the reproductive and/or developmental consequences of gestational and lactational mercury exposure from fish consumption and/or dental amalgam, no studies have assessed the possible effects of the long-term use of mercury-containing skin-lightening products by women of childbearing age on their pregnancy outcome and children's health. This commentary aims to collate information on the popular use of mercury-containing skin-lightening creams and sheds the light to the readers about the limitations of the available data on its impact during a prenatal and/or postnatal period. There is an urgent need to assess the adverse health effects of applying these products during pregnancy or lactation on child growth and development through birth cohort studies. Until data from these studies are available, women should be advised not to use topical skin-lightening creams during pregnancy and lactation.

Minimal change disease caused by exposure to mercury-containing skin lightening cream: a report of 4 cases

Mercury is a known cause of nephrotic syndrome and the underlying renal pathology in most of the reported cases was membranous nephropathy. We describe here 4 cases of minimal change disease following exposure to mercury-containing skin lightening cream for 2 - 6 months. The mercury content of the facial creams was very high (7,420 - 30,000 parts per million). All patients were female and presented with nephrotic syndrome and heavy proteinuria (8.35 - 20.69 g/d). The blood and urine mercury levels were 26 - 129 nmol/l and 316 - 2,521 nmol/d, respectively. Renal biopsy revealed minimal change disease (MCD) in all patients. The use of cosmetic cream was stopped and chelation therapy with D-penicillamine was given. Two patients were also given steroids. The time for blood mercury level to normalize was 1 - 7 months, whereas it took longer for urine mercury level to normalize (9 - 16 months). All patients had complete remission of proteinuria and the time to normalization of proteinuria was 1 - 9 months. Mercury-containing skin lightening cream is hazardous because skin absorption of mercury can cause minimal change disease. The public should be warned of the danger of using such products. In patients presenting with nephrotic syndrome, a detailed history should be taken, including the use of skin lightening cream. With regard to renal pathology, apart from membranous nephropathy, minimal change disease should be included as another pathological entity caused by mercury exposure or intoxication.

Pediatric mercury poisoning, brain MRI, and white matter hyperintensities

-weighted MRimages of the brain, Benz et al. [1] describe a 4-year-oldgirl with a nonfatal percutaneous inorganic mercuryintoxication due to topical application of mercury-containing skin lightening cream. The authors are to becommended on their case report as they also provide anexcellent discussion of the effects of chelation therapy with2,3-dimercapto-1-propanesulfonic acid. In the “Introductionsection” of their case report, Benz et al. state that, “Dataabout magnetic resonance imaging (MRI) findings inintoxication from inorganic Hg did not exist up to now” [1].We wonder if they are aware that diffuse and punctiformsubcortical WMLs on T

Beastly Beauty Products: Exposure to Inorganic Mercury in Skin-Lightening Creams

Vol. 119, No. 2 NewsOpen AccessBeastly Beauty Products: Exposure to Inorganic Mercury in Skin-Lightening Creams Cynthia Washam Cynthia Washam Search for more papers by this author Published:1 February 2011https://doi.org/10.1289/ehp.119-a80bCited by:4AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit The most common exposure to mercury is from organic methylmercury found in fish. People with no workplace exposure to mercury typically have low levels of exposure to inorganic or elemental mercury, although nonoccupational exposure can occur from dental amalgams, some herbal medicine products, and cosmetics that contain mercury. When a New York City (NYC) biomonitoring study revealed that thousands of women in that city may have been exposed to dangerous levels of inorganic mercury from imported skin-lightening creams, city health officials enlisted the help of U.S. and international health agencies in getting the creams off local store shelves [EHP119(2):203–209; McKelvey et al.].In 2004 the NYC Department of Health and Mental Hygiene (DOHMH) conducted the nation’s first local Health and Nutrition Examination Survey. Analysis of urine specimens from 1,840 adult New Yorkers collected during the survey yielded a geometric mean mercury concentration of 0.73 μg/L, slightly higher than the national average of 0.5 μg/L. The authors took note when 13 women were found to have urine mercury concentrations exceeding the state’s reportable level of 20 μg/L; 4 women had levels exceeding 50 μg/L.All 13 highly exposed women were Hispanic or black, and 10 had been born in the Dominican Republic. Each of the 9 women interviewed on followup had used mercury-containing skin-lightening cream. One such product sampled by DOHMH workers contained 6,190 ppm mercury. The U.S. Food and Drug Administration (FDA) limit for mercury in skin-care products is 1 ppm.Extrapolating from the population sampled, the authors estimate nearly 27,000 New Yorkers may have urine mercury levels exceeding 20 μg/L. Although the researchers did not assess potential health effects among the highly exposed women, occupational studies indicate kidney and neurologic toxicity may occur when urine mercury levels exceed 20 μg/L.City health officials responded to the survey results by seizing 12 brands of illegally imported cosmetics from store shelves. All the products listed mercury as an active ingredient. Press releases issued by the DOHMH urged residents to report mercury-tainted cosmetics and the shops selling them, and New Jersey investigators were enlisted to plug the pipeline to importers in that state. The Pan American Health Organization called on the Dominican Republic to stop manufacturing the dangerous products. The Dominican Secretary of Health reportedly has notified all laboratories to stop manufacturing mercury-containing skin-care products.The authors realize some tainted products may still cross the border, as they have for years despite FDA prohibitions. But they believe their efforts, coupled with evidence of mercury’s toxicity and continued vigilance, will substantially reduce the availability and use of these products.Only half the sampled products listed mercury on the label. Most exceeded the FDA limit for mercury in personal care products by several hundred or thousand times.FiguresReferencesRelatedDetailsCited by Al-Saleh I (2016) Potential health consequences of applying mercury-containing skin-lightening creams during pregnancy and lactation periods, International Journal of Hygiene and Environmental Health, 10.1016/j.ijheh.2016.03.002, 219:4-5, (468-474), Online publication date: 1-Jul-2016. Chatterjee S, Sarkar S and Bhattacharya S (2014) Toxic Metals and Autophagy, Chemical Research in Toxicology, 10.1021/tx500264s, 27:11, (1887-1900), Online publication date: 17-Nov-2014. Yang H, Chen P, Ho P and Shih Y (2014) Direct Analysis of Mercury in Cosmetics Using Screen-Printed Silver Electrodes and Flow Injection Analysis, Journal of The Electrochemical Society, 10.1149/2.057406jes, 161:6, (B137-B142), . Secor J, Kotha S, Gurney T, Patel R, Kefauver N, Gupta N, Morris A, Haley B and Parinandi N (2011) Novel Lipid-Soluble Thiol-Redox Antioxidant and Heavy Metal Chelator, N , N ′-bis(2-Mercaptoethyl)Isophthalamide (NBMI) and Phospholipase D-Specific Inhibitor, 5-Fluoro-2-Indolyl Des-Chlorohalopemide (FIPI) Attenuate Mercury-Induced Lipid Signaling Leading to Protection Against Cytotoxicity in Aortic Endothelial Cells , International Journal of Toxicology, 10.1177/1091581811422413, 30:6, (619-638), Online publication date: 1-Dec-2011. Vol. 119, No. 2 February 2011Metrics About Article Metrics Publication History Originally published1 February 2011Published in print1 February 2011 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. 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Population-based inorganic mercury biomonitoring and the identification of skin care products as a source of exposure in New York City.

BackgroundMercury is a toxic metal that has been used for centuries as a constituent of medicines and other items.ObjectiveWe assessed exposure to inorganic mercury in the adult population of New York City (NYC).MethodsWe measured mercury concentrations in spot urine specimens from a representative sample of 1,840 adult New Yorkers in the 2004 NYC Health and Nutrition Examination Survey. Cases with urine concentrations ≥ 20 μg/L were followed up with a telephone or in-person interview that asked about potential sources of exposure, including ritualistic/cultural practices, skin care products, mercury spills, herbal medicine products, and fish.ResultsGeometric mean urine mercury concentration in NYC was higher for Caribbean-born blacks [1.39 μg/L; 95% confidence interval (CI), 1.14–1.70] and Dominicans (1.04 μg/L; 95% CI, 0.82–1.33) than for non-Hispanic whites (0.67 μg/L; 95% CI, 0.60–0.75) or other racial/ethnic groups. It was also higher among those who reported at least 20 fish meals in the past 30 days (1.02 μg/L; 95% CI, 0.83–1.25) than among those who reported no fish meals (0.50 μg/L; 95% CI, 0.41–0.61). We observed the highest 95th percentile of exposure (21.18 μg/L; 95% CI, 7.25–51.29) among Dominican women. Mercury-containing skin-lightening creams were a source of exposure among those most highly exposed, and we subsequently identified 12 imported products containing illegal levels of mercury in NYC stores.ConclusionPopulation-based biomonitoring identified a previously unrecognized source of exposure to inorganic mercury among NYC residents. In response, the NYC Health Department embargoed products and notified store owners and the public that skin-lightening creams and other skin care products that contain mercury are dangerous and illegal. Although exposure to inorganic mercury is not a widespread problem in NYC, users of these products may be at risk of health effects from exposure.

Membranous nephropathy caused by mercury-containing skin lightening cream.

A 46 year old woman developed membranous nephropathy following the use of a mercury-containing skin lightening cream. This association has not been reported in the literature for over a decade and apparently never from this country. It is important that clinicians are aware of this usually eminently treatable cause of the nephrotic syndrome as it is likely to be missed unless specifically enquired for.

Tissue mercury levels in the mercury-induced nephrotic syndrome.

Levels of mercury in scalp hair, pubic hair, and fingernails were found to reflect the use of mercury-containing skin-lightening creams, the causal agents of many cases of the adult nephrotic syndrome seen in Africans in Kenya.

Levels of mercury in urine correlated with the use of skin lightening creams.

The pattern of use of mercury-containing skin lightening creams in a group of young healthy African women was strikingly reflected by the excretion of mercury in urine. Although the levels of mercury in urine frequently associated with manifestations of systemic toxicity were not observed, the mean concentration of mercury in urine, at random sampling, was significantly more than the acceptable upper limit of normal in the group of subjects using mercury-containing skin lightening creams at the time of study. When use of these preparations was discontinued, progressive reduction in mercury concentration in urine Was manifest. Continued use, however, resulted in a variable pattern of subsequent excretion of mercury in urine for which a probable explanation is presented. No definite evidence o of renal damage was obtained, and in particular there were no stigmata of the nephrotic syndrome. The previously published data concerning the association of the nephrotic syndrome with exposure to mercury is reviewed. It is felt that in this respect the subjects of this study constitute a vulnerable population.

Nephrotic syndrome in adult Africans in Nairobi.

The adult nephrotic syndrome as met with in Nairobi is predominantly encountered in young sophisticated African women, most of whom began to use skin-lightening creams containing mercury before the symptomatic onset of their illness. The particular form of mercury involved is well known to cause the nephrotic syndrome in other circumstances-for example, when applied to the skin in the treatment of psoriasis. In these circumstances the pathogenetic mechanism is thought to be of an idiosyncratic type. The use of mercury-containing skin-lightening creams in the patients studied seemed to be particularly associated with a "minimal-change" ("light-negative") renal glomerular lesion, this lesion being present in half of the patients. The prognosis in this group of patients seems remarkably good, with 50% entering remission, 77% of these doing so spontaneously on discontinuing the use of the creams.