Mercury poisoning from use of face cream

Dr Kakoli Choudhury, Specialist Registrar

Dr Jill Morris, Consultant

Thames Valley Health Protection Unit

Thanks to Henrietta Harrison, Unit Head, & Rebecca Gay, CRCE Chilton

24th Sept 2010

Overview

• Notification

• Actions taken by TVHPU

• Actions taken by Trading Standards

• Actions taken by CRCE

• Subsequent actions

• Conclusion

Notification

•Received by TVHPU on 19th August 2009 at 12:56 PM

•Initial notification – 2 cases – half-sisters

Presentations

Patient 1

Chronic back pain since 2007

Nephrotic syndrome detected in March 2009

Blood mercury – 150 nmol/L (normal <30 nmol/L)

Patient 2

Chronic back pain

Blood mercury – 65.3 nmol/L

Confirmation of source

Face cream mercury – 2.04% by weight

(normal – 0)

TVHPU actions

• Checked HPA Compendium & NPIS (ToxBase)

• Notified CRCE

• Asked GP to look for alternative sources & test controls

• Confirmed that face cream was tested in accredited lab

• Contacted Lambeth Trading Standards

• IRIS

Trading Standards’ actions

• Visited the internet trader

• Trader mixes creams on dining table

• Three samples sent for mercury levels

• Trader agreed to immediately cease supply

• Trader agreed to supply customer names & contact details

Health effects

Blood mercury levels

Patient 1 Patient 2 Control 1 Control 2

150 nmol/L 65.3 nmol/L 4.2 nmol/L 10.2 nmol/L

3rd patient

•Nephrotic syndrome

•Blood mercury – 198 nmol/L

Source – 3 face creams bought in Birmingham

Mercury levels – 0.25% - 3.5%

Blood mercury results

1st result 2nd result (after stopping face cream)

Patient 1 150 nmol/L 59.3 nmol/L

Patient 2 65.3 nmol/L 66.1 nmol/L

Patient 3 198 nmol/L 58.6 nmol/L

Not an unusual event

• Membranous nephropathy caused by mercury-containing skin lightening cream

• Mercury Toxicity due to use of a cosmetic cream

• An epidemiological survey of the use of cosmetic skin lightening cosmetics among traders in Lagos, Nigeria

• Complications of chronic use of skin lightening cosmetics

• Large-scale mercury exposure due to a cream cosmetic: community-wide case series

• Mercury poisoning associated with a Mexican beauty cream

• Etc etc

Actions taken by CRCE

• 29 customers identified by trader were contacted via e-mails/letter

• European partners were informed

• GPs in England were informed for awareness

• Devolved governments were informed

• National Renal Association was informed for awareness

Subsequent actions

• CRCE collated all reported cases

• Trading Standards’ investigation is ongoing

• Public Health information and leaflet have been produced by CRCE. These will be available on HPA website and circulated to PCTs for onward circulation

UK/EU legislation

Two Simple ways To Identify Possible Dangerous Creams

By law, cosmetics MUST have the name and address of the manufacturer or importer into the EU on the product.

By law, cosmetics MUST have a list of ingredients on the packaging or enclosed leaflet.

Conclusion

• Public need to be aware of the dangers of using illegal cosmetics

• Clinicians need to be aware of the symptoms of mercury poisoning

• Leaflets and FAQs can be accessed from www.hpa.org.uk/chemicals/mercury