Mercury pigmentation and high mercury levels from the use of a cosmetic cream

Drug-Induced Pigmentation: A Review

Drug-induced pigmentation (DIP) is estimated to account for 20% of all cases of acquired hyperpigmentation. Over 50 agents have been implicated, including antibiotics, antimalarials, antiretrovirals, antipsychotics, prostaglandin analogs, heavy metals, and chemotherapeutic agents. The skin, mucosal surfaces, nails, and hair can all be affected, with the color, distribution, onset, and duration of pigmentation varying between offending agents. Both a thorough physical examination and medication history are necessary to determine the offending agent. In terms of mechanism, DIP occurs most frequently through the accumulation of melanin within the dermis but also by drug accumulation, pigment synthesis, and iron deposition. Photoprotection, including applying a broad-spectrum sunscreen, wearing photoprotective clothing, and seeking shade, plays an important role in the prevention of exacerbation of DIP. Multiple lasers, including the picosecond alexandrite, Q-switched Nd:YAG, Q-switched alexandrite, and Q-switched ruby lasers, have been successful in obtaining clearance of DIP. In this review, we examine the unique characteristics of each of the inciting agents in terms of incidence, clinical presentation, time to onset and resolution, and pathogenesis.

Sequential Injection Analysis for Rapid Determination of Mercury in Skincare Products Based on Fluorescence Quenching of Eco-Friendly Synthesized Carbon Dots

This work reports the analysis of mercury using a spectrofluorometric method combined with a sequential injection analysis (SIA) system. This method is based on the measurement of fluorescence intensity of carbon dots (CDs), which is quenched proportionally after adding mercury ions. Herein, the CDs underwent environmentally friendly synthesis using a microwave-assisted approach that provides intensive and efficient energy and shortens reaction time. After irradiation at 750 W for 5 min in a microwave oven, a dark brown CD solution with a concentration of 2.7 mg mL^-1 was obtained. The properties of the CDs were characterized by transmission electron microscopy, X-ray diffractometry, X-ray photoelectron spectroscopy, Fourier-transform infrared spectroscopy, and UV-vis spectrometry. We presented for the first time the use of CDs as a specific reagent for the determination of mercury in skincare products with the SIA system to achieve rapid analysis and full automatic control. The as-prepared CD stock solution was diluted 10 times and used as a reagent in the SIA system. Excitation and emission wavelengths at 360 and 452 nm, respectively, were used to construct a calibration curve. Physical parameters affecting the SIA performance were optimized. In addition, the effect of pH and other ions was investigated. Under the optimum conditions, our method showed a linear range from 0.3 to 600 mg L^-1 with an R ² of 0.99. The limit of detection was 0.1 mg L^-1. Relative standard deviation was 1.53% (n = 12) with a high sample throughput of 20 samples per hour. Finally, the accuracy of our method was validated by comparison using inductively coupled plasma mass spectrometry. Acceptable recoveries were also presented without a significant matrix effect. This method was also the first time that uses the untreated CDs for the determination of mercury(II) in skincare products. Therefore, this method could be an alternative for mercuric toxic control in other sample applications.

Cosmetic Syndrome Correction with Calcium Hydroxylapatite-Based Filler in Patients with Connective Tissue Dysplasia

Undifferentiated connective tissue dysplasia is one of the most common diseases of nowadays, which does not fit into the group of hereditary syndromes. This condition is diagnosed in 20–50% of the population at any age. The study aimed to correct the facial soft tissues of patients with undifferentiated connective tissue dysplasia through the cosmetic procedure of calcium hydroxylapatite injection. In 2018, a 36-year-old patient addressed the beauty salon with signs of undifferentiated connective tissue dysplasia, such as severe asymmetry of the face, infraorbital and nasolabial sulci, and thin and easily folding skin. Signs were observed from the age of 22, i.e., for 14 years. The therapy was performed using special features of the correction of facial soft tissue changes in patients with connective tissue dysplasia (CTD) using calcium hydroxylapatite-based products (Radiesse®, Merz North America, Inc., USA). Particular attention is given to the need for early correction to prevent premature skin aging related to this condition. After 14 days, a significant improvement of the patient's skin condition was noted after the passing of two procedures. Her condition was estimated as consistent with T1-2P0G0A1Zh1 P1M1K1 and corresponded to grade I age-related changes in the superficial soft tissues. The performed treatment showed high efficacy in case of mild connective tissue dysplasia diagnosis. The results showed that when collecting information from anamnesis, the diagnostic criteria for dysplasia should be considered. If the criteria are met, the cosmetological correction with collagen stimulators becomes possible.

Effects of Skin Lightening Cream Agents - Hydroquinone and Kojic Acid, on the Skin of Adult Female Experimental Rats

Introduction

Skin bleaching is the act of using steroid- and chemical-containing products to lighten the skin. Hydroquinone and kojic acid are often used in skin bleaching creams. Hydroquinone was suspected to be harmful. This study investigated the effects of kojic acid and hydroquinone on the skin of adult female Wistar rats and the potential use of aloe vera for amelioration.

Materials and Methods

Eighty [n=80] adult female Wistar rats with an average weight of 120 g were randomly divided into eight groups, marked A, B, C, D, E, F, G, and H. Group A animals served as the control group; group B was treated with 2% hydroquinone, group C was treated with 2% kojic acid, group D was treated with 4% hydroquinone, group E was treated with 4% kojic acid, group F was treated with 2% hydroquinone and 2% kojic acid, group G was treated with 4% hydroquinone and 4% kojic acid, and group H was treated with 4% hydroquinone, 4% kojic acid, and aloe vera. The preparations were applied to the tail skin and treatment lasted 28 days. Skin samples were excised and processed using H&E, Masson’s trichrome, and p65 immunohistochemical assays on tissue sections.

Results

Hydroquinone caused structural disruptions of the stratum corneum of the epidermis and the overlying keratin. p65 was also prominently expressed in the treated groups. Hydroquinone reduced skin thickness and caused epidermis disruption.

Discussion

The prominent expression of p65 in the sections indicated deleterious effects of hydroquinone. Kojic acid was not found to have deleterious effects. Aloe vera prevented extensive disruption of stratum corneum by hydroquinone. The use of hydroquinone in skin lightening creams might raise health concerns. Aloe vera could be protective against hydroquinone.

Mercuric chloride poisoning: symptoms, analysis, therapies, and autoptic findings. A review of the literature

Among mercury-related intoxications, the re-emerging of mercuric chloride poisoning has been recently described in literature. Only sparse data, reporting the clinical symptoms, the anatomo-pathological findings, the analytical procedures or the treatment have been published and no exhaustive analysis of all these factors exists in literature. The classic symptoms associated with toxicity of mercuric chloride is a combination of renal, gastrointestinal (GI) and central nervous system (CNS) damages, eventually leading to death. Fatalities related to exposure to mercuric chloride have been reported since the nineteenth century. To date, there have been 45 published cases in the medical literature in which the intoxication or the death is attributed to mercuric chloride. In this review, we will describe the modern medical treatments, with particular attenztion to the developments of the lasts two decades, in order to provide an exhaustive description of the clinical symptoms, the post-mortem findings, and the analytical procedures to act out when mercuric chloride intoxication occurs. The analysis of the data obtained permitted us to accurately describe all the organs and apparatus involved in mercuric chloride intoxication. The target organs were the kidneys, the GI tract and the CNS. A description of the analytical procedures for the determination of mercuric chloride in biological materials, to carry out in vivo and in post-mortem samples has also been described.

Skin Bleaching Among African and Afro-Caribbean Women in New York City: Primary Findings from a P30 Pilot Study

INTRODUCTION

The application of skin bleaching products to inhibit melanogenesis is a common practice within the African diaspora. Despite the adverse health effects of skin bleaching, rigorous studies investigating skin bleaching behavior among these populations in the United States are limited. In our P30 pilot study, we explored predictors of skin bleaching practice intensity among African and Afro-Caribbean women.

METHODS

In collaboration with our Community Engagement Core, we conducted a cross-sectional study to investigate the relationship between demographic and psychosocial predictors and skin-bleaching-related practice patterns among African and Afro-Caribbean women in New York City.

RESULTS

Among the 76 participants recruited, the median age at the initiation of skin bleaching was 19.5 (16-25) years, yielding a median duration of 13.5 (6-23) years. Although pregnant women were not actively recruited for the study, 13.2% (n = 10) of the participants used skin bleaching products while pregnant or possibly breastfeeding. Nativeness and education were associated with various components of skin bleaching practice intensity, including duration of skin bleaching, daily use of products, and bleaching of the entire body. Participants' perceived skin-color-related quality of life was not associated with skin bleaching practice intensity.

CONCLUSION

Skin bleaching is a habitual practice that likely requires culturally sensitive interventions to promote behavioral change. The existence of prenatal and postnatal exposure to mercury, hydroquinone, and other potentially harmful chemicals in skin bleaching products highlights an urgent need to explore the adverse effects of skin bleaching practices on birth outcomes and the growth and neurodevelopment of young babies.

The global prevalence and correlates of skin bleaching: a meta-analysis and meta-regression analysis

PURPOSE

To estimate and investigate the global lifetime prevalence and correlates of skin bleaching.

METHODS

A meta-analysis and meta-regression analysis was performed based on a systematic and comprehensive literature search conducted in Google Scholar, ISI Web of Science, ProQuest, PsycNET, PubMed, and other relevant websites and reference lists. A total of 68 studies (67,665 participants) providing original data on the lifetime prevalence of skin bleaching were included. Publication bias was corrected using the trim and fill procedure.

RESULTS

The pooled (imputed) lifetime prevalence of skin bleaching was 27.7% (95% CI: 19.6-37.5, I²  = 99.6, P < 0.01). The highest significant prevalences were associated with: males (28.0%), topical corticosteroid use (51.8%), Africa (27.1%), persons aged ≤30 years (55.9%), individuals with only primary school education (31.6%), urban or semiurban residents (74.9%), patients (21.3%), data from 2010-2017 (26.8%), dermatological evaluation and testing-based assessment (24.9%), random sampling methods (29.2%), and moderate quality studies (32.3%). The proportion of females in study samples was significantly related to skin bleaching prevalence.

CONCLUSION

Despite some limitations, our results indicate that the practice of skin bleaching is a serious global public health issue that should be addressed through appropriate public health interventions.

Pigmented Deposits in the Skin

Pigmented deposits can occur in the skin due to many and varied causes. Some of them are systemic conditions accompanied by involvement of internal organs. Others have serious prognostic implications, and early diagnosis can help in the correct and adequate management of the diseases. In addition, some of them are quite innocuous and the correct diagnosis avoids unnecessary treatments. In this article, we review the morphologic features of some of the most common and some of the less usual pigmented deposits in skin other than tattoos.

Evaluation of the effects of chronic intoxication with inorganic mercury on memory and motor control in rats

The aims of this study were to evaluate whether chronic intoxication with mercury chloride (HgCl₂), in a low concentration over a long time, can be deposited in the central nervous tissue and to determine if this exposure induces motor and cognitive impairments. Twenty animals were intoxicated for 45 days at a dose of 0.375 mg/kg/day. After this period, the animals underwent a battery of behavioral tests, in a sequence of open field, social recognition, elevated T maze and rotarod tests. They were then sacrificed, their brains collected and the motor cortex and hippocampus dissected for quantification of mercury deposited. This study demonstrates that long-term chronic HgCl₂ intoxication in rats promotes functional damage. Exposure to HgCl₂ induced anxiety-related responses, short- and long-term memory impairments and motor deficits. Additionally, HgCl₂ accumulated in both the hippocampus and cortex of the brain with a higher affinity for the cortex.

Spectrometric analysis of mercury content in 549 skin-lightening products: is mercury toxicity a hidden global health hazard?

BACKGROUND

Cosmetic skin lightening is practiced worldwide. Mercury is a well-documented melanotoxin added to some lightening products. However, mercury can cause many dermatologic, renal, and neurologic problems. The Food and Drug Administration limits the amount of mercury in cosmetic products to trace amounts, 1 ppm.

OBJECTIVE

The objective of this study was to quantitatively evaluate a large international sample of lightening products for mercury content, focusing on products available to US consumers either online or in stores.

METHODS

A total of 549 skin-lightening products, manufactured in 32 countries, were purchased online in the United States, Taiwan, and Japan and in stores in the United States, China, Taiwan, Thailand, Japan, and Sri Lanka. Cosmetics were screened for mercury content above 200 ppm using a low-cost portable x-ray fluorescence spectrometer.

RESULTS

Of the 549 tested products, 6.0% (n = 33) contained mercury above 1000 ppm. In all, 45% of mercury-containing samples contained mercury in excess of 10,000 ppm. Of lightening products purchased in the United States, 3.3% were found to contain mercury in excess of 1000 ppm.

LIMITATIONS

Our study did not evaluate creams for other melanosuppressive ingredients. Only 1 sample of each product was tested.

CONCLUSION

Our study confirms the national and global presence of mercury in skin-lightening products.

Skin bleaching: highlighting the misuse of cutaneous depigmenting agents

Hydroquinone and other cutaneous depigmenting agents are widely used by dermatologists to treat pigmentary disorders. On 29 August 2006, the US Food and Drug Administration (FDA) published a monograph in the US Federal Register proposing to ban all hydroquinone products that have not been approved via a New Drug Application process. Reports in the scientific literature on the occurrence of exogenous ochronosis, in relation to the use of hydroquinone, was one of the concerns expressed by the FDA in relation to this agent. However, a review of the English-language scientific literature reveals that most of the reported cases of hydroquinone-induced exogenous ochronosis occurs in Africa, where the cultural practice of skin bleaching is highly prevalent. Skin bleaching is the practice of applying hydroquinone and/or other depigmenting agents to specific or widespread areas of the body, the primary function being to lighten normally dark skin. This practice typically occurs in men and women with Fitzpatrick skin phototypes IV to VI. It is a dangerous practice associated with a diverse range of side-effects, including mercury poisoning. Thus, this current discussion within the dermatological community on the safety of hydroquinone provides a unique opportunity to raise awareness about skin bleaching.

Molecular mechanisms triggered by mercury

Mercury is an ubiquitous environmental toxin that causes a wide range of adverse health effects in humans. Three forms of mercury exist: elemental, inorganic and organic. Each of them has its own profile of toxicity. Exposure to mercury typically occurs by inhalation or ingestion. Mercury can be an indoor air pollutant, however industry emission remains the most important source of inhaled mercury. Furthermore, fresh water and ocean fish may contain large amounts of mercury and dental amalgam can be another important source of inorganic and mercury vapor. The present review discusses the current information on mercury toxicity and the distinct toxicologic profile of the three forms of mercury. The existing therapeutics, new therapeutics development or agents for treating mercury poisoning will also discussed. Since in general low levels of mercurial are tolerable, herein, we also discuss the defensive mechanisms developed by the cell to protect itself against mercury injury. This aspect may be useful to provide a biological protection against toxic effects exerted by mercury or by specific forms of mercury in view of a medicinal purposes.

Mercury exposure and public health

Mercury is a metal that is a liquid at room temperature. Mercury has a long and interesting history deriving from its use in medicine and industry, with the resultant toxicity produced. In high enough doses, all forms of mercury can produce toxicity. The most devastating tragedies related to mercury toxicity in recent history include Minamata Bay and Niagata, Japan in the 1950s, and Iraq in the 1970s. More recent mercury toxicity issues include the extreme toxicity of the dimethylmercury compound noted in 1998, the possible toxicity related to dental amalgams, and the disproved relationship between vaccines and autism related to the presence of the mercury-containing preservative, thimerosal.

Mercury exposure in children: a review

Exposure to toxic mercury (Hg) is a growing health hazard throughout the world today. Recent studies show that mercury exposure may occur in the environment, and increasingly in occupational and domestic settings. Children are particularly vulnerable to Hg intoxication, which may lead to impairment of the developing central nervous system, as well as pulmonary and nephrotic damage. Several sources of toxic Hg exposure in children have been reported in biomedical literature: (1) methylmercury, the most widespread source of Hg exposure, is most commonly the result of consumption of contaminated foods, primarily fish; (2) ethylmercury, which has been the subject of recent scientific inquiry in relation to the controversial pediatric vaccine preservative thimerosal; (3) elemental Hg vapor exposure through accidents and occupational and ritualistic practices; (4) inorganic Hg through the use of topical Hg-based skin creams and in infant teething powders; (5) metallic Hg in dental amalgams, which release Hg vapors, and Hg2+ in tissues. This review examines recent epidemiological studies of methylmercury exposure in children. Reports of elemental Hg vapor exposure in children through accidents and occupational practices, and the more recent observations of the increasing use of elemental Hg for magico-religious purposes in urban communities are also discussed. Studies of inorganic Hg exposure from the widespread use of topical beauty creams and teething powders, and fetal/neonatal Hg exposure from maternal dental amalgam fillings are reviewed. Considerable attention was given in this review to pediatric methylmercury exposure and neurodevelopment because it is the most thoroughly investigated Hg species. Each source of Hg exposure is reviewed in relation to specific pediatric health effects, particularly subtle neurodevelopmental disorders.

Transdermal kinetics of a mercurous chloride beauty cream: an in vitro human skin analysis

BACKGROUND

Crema de Belleza-Manning is a popular mercurous chloride-containing beauty cream used to smooth and lighten the complexion and treat acne. Hundreds of people in the Southwestern US border states have been identified with elevated (>20 microg/L) urine mercury levels believed to be secondary to using this cream. The kinetic characteristics of percutaneous mercury absorption are incompletely defined. The objective of this study was to determine the transdermal kinetics of two formulations of mercurous chloride from a beauty cream in an in vitro human skin model.

METHODS

A proprietary formulation and an aqueous formulation of the beauty cream were studied using modified Franz diffusion cells. Mercury content in the skin samples and the underlying diffusion buffer was determined using atomic absorption spectrophotometry.

RESULTS

A rapid initial increase in mercury content both in the skin and the buffer was noted for both formulations. Mercury concentrations in the aqueous samples were significantly (p < 0.05) higher in both the skin and the diffusion buffer compared to parallel samples containing glycerol.

CONCLUSIONS

Mercury was readily absorbed through the skin in this in vitro human skin model. The aqueous preparation had a markedly increased rate and extent of mercury absorption relative to the proprietary formulation.

Mercury exposure and cutaneous disease

Human contact with mercury has been ongoing for centuries and was previously considered a legitimate means of treating different cutaneous and systemic conditions. Toxicity from this heavy metal may occur from exposure to elemental, inorganic, and organic forms of mercury. This article outlines the signs and symptoms of mercury poisoning and the different clinical conditions with assorted cutaneous findings.

Mercury poisoning associated with a Mexican beauty cream

OBJECTIVES

To describe demographic characteristics, patterns of use, and symptoms associated with mercury poisoning among persons who used a Mexican beauty cream containing mercurous chloride and to estimate the prevalence of cream use in Texas near the Mexico border.

DESIGN

Case series and cross-sectional survey.

SETTING

Border communities of Arizona, California, New Mexico, and Texas.

PARTICIPANTS

Persons who used the cream and contacted a health department in response to announcements about the cream and households that participated in the Survey of Health and Environmental Conditions in Texas Border Counties and Colonias, 1997.

MAIN OUTCOME MEASURES

Urine mercury concentrations, self-reported symptoms, and prevalence of cream use among households.

RESULTS

Of 330 cream users who contacted their health department, 96% were women, and 95% were Hispanic. The mean urine mercury concentration was 146.7 microg/L (reference range : 0-20 microg/L). In 5% of 2,194 randomly selected Texas households near the Mexico border, at least 1 person had used "Crema de Belleza-Manning" (Laboratorios Vida Natural, S.A., Tampico, Tamaulipas, Mexico) in the previous year.

CONCLUSIONS

Most cream users had increased urine mercury concentrations. Cream use was common in Texas near the Mexico border. Physicians should consider toxicity in patients with neurologic symptoms of unclear cause and use public health departments when investigating unusual illnesses.

Peripheral polyneuropathy due to chronic use of topical ammoniated mercury

BACKGROUND

Despite their potentially disastrous side effects, topical mercury salts can still be found as ingredients in some over-the-counter preparations or local remedies.

CASE REPORT

Peripheral polyneuropathy as a result of chronic ammoniated mercury poisoning was studied and followed over 2 years. A 36-year-old man developed peripheral polyneuropathy following chronic perianal use of an ammoniated mercury ointment. Highly elevated blood and urine mercury levels were found. Sural nerve biopsy showed mixed axonal degeneration-demyelination. There was progressive improvement of his symptoms over 2 years but neurophysiological examination revealed incomplete recovery.

CONCLUSION

The availability of safer drugs should result in a complete ban of these dangerous compounds.

Heavy metal toxicity, Part I: arsenic and mercury

This review is Part I of a two-part series focusing on heavy metal toxicity. Part I will cover arsenic and mercury toxicity. Acute and chronic arsenic toxicity, as well as arsine gas toxicity, will be reviewed. The clinical presentation, with focus on the nervous, cardiovascular, pulmonary, gastrointestinal, hepatic, renal, hematopoietic, and dermatologic systems, is delineated. Mercury exposure, including exposure to short chain alkyl mercury, elemental mercury, and acute inorganic salt, is reviewed. The discussion of clinical toxicity focuses on the nervous, cardiovascular, pulmonary, gastrointestinal, and renal systems, as well as on the teratogenic effects of mercury. Recommendations for diagnostic tests and management plans are discussed, including chelation regimens.

Mercury content in skin-lightening creams and potential hazards to the health of Saudi Women

It seems evident from a wealth of scientific research that mercury is toxic. Because of the nature of the Saudi markets, different brands of skin-lightening creams are widely available. In this study, 38 skin-lightening cream samples were collected and analyzed for mercury by inductively coupled plasma spectrometry after an acid digestion procedure. About 45% of the tested skin-lightening cream samples contained mercury at levels well above the FDA's acceptable limit of 1 ppm. These findings are alarming and have wide legal and educational implications for Saudi Arabia in particular and developing countries in general. Further investigation for possible adverse health effects is also needed.

A report on the composition of mercurials used in traditional medicines in Oman

A brick red powder, used by a 'native physician' (a practitioner of traditional medicine in Oman) to treat a female patient for vitiligo, has been analysed by X-ray powder diffraction and scanning electron microscopy (S.E.M.). It was found to be a mixture of cinnabar (HgS) and calomel (Hg2Cl2). Symptoms of acute mercury poisoning resulted from the patient repeatedly breathing in elemental mercury vapour after this brick red powder and elemental mercury encased in a lime, were thrown on an open fire in a closed room. The patient also presented with central nervous system toxicity which improved gradually after treatment with Dimercaprol was discontinued. The use of mercurials as traditional medicines in Oman is briefly reviewed; as is the variation in literature values for 'normal'/'abnormal'/toxic levels of mercury in human blood.

Physiological and toxicological changes in the skin resulting from the action and interaction of metal ions

The human environment contains more than 50 metal or metalloid elements. At least 15 are recognized as trace elements, with zinc, calcium, copper, magnesium, and iron having specific roles in skin morphogenesis and function. The present review focuses on the presumed role of metal ions in the skin, their competition for carrier proteins, and membrane receptors. Evidence presented shows that the balance of trace metal ions is critical for normal skin and repair mechanisms following injury. Xenobiotic ions can impair this balance, leading to pathological change. The skin acts as an organ of elimination of excess trace metals and xenobiotic ions from the body, but mechanisms of voidance vary for different metals. Metal ions are an important cause of allergies, and evidence is presented to show that the majority of metals or metal compounds can induce allergic changes. Except for chromium and nickel, which are among the most common human allergens, animal models have provided little information. At least cadmium, thorium, lead, chromium, nickel, beryllium, and arsenic and proven or putative carcinogens in animals or humans on the basis of cytological or epidemiological evidence. However, only arsenic exhibits a clear predilection for the skin. Other metals such as gold can induce subcutaneous sarcoma following injection, but the relevance of this observation in terms of human occupational risk is discounted.