Update: Mercury Poisoning Associated with Beauty Cream --
Arizona, California, New Mexico, and Texas, 1996
During September 1995-May 1996, the Texas Department of Health
(TDH), the New Mexico Department of Health (NMDH), and the San
Diego County (California) Health Department investigated three
cases of mercury poisoning associated with the use of a
mercury-containing beauty cream produced in Mexico (1). The ongoing
investigation has found this product in shops and flea markets in
the United States located near the U.S.-Mexico border, and a U.S.
distributor has been identified in Los Angeles. The cream, marketed
as "Crema de Belleza -- Manning" for skin cleansing and prevention
of
acne, listed "calomel" (mercurous chloride {Hg2Cl2}) as an
ingredient and contained 6% to 10% mercury by weight (1). This
report presents findings of a continuing investigation by these
health departments, the Arizona Dept of Health Services (ADHS),
California State Department of Health Services (CSDHS), the Food
and Drug Administration (FDA), and CDC.
In response to media announcements in Arizona, California, New
Mexico, and Texas, 238 persons (89 in Arizona, 65 in California, 36
in New Mexico, and 48 in Texas) contacted their health departments
to report use of the cream. Of the 119 persons for whom urinalysis
has been completed, 104 (87%) had elevated mercury levels (defined
as a level greater than 20 ug/L) (27 {87%} of 31 in Arizona, 35
{83%} of 42 in California, 28 {88%} of 32 in New Mexico, and 14
{100%} of 14 in Texas); 27 (26%) of the 104 had levels greater than
200 ug/L. Elevated mercury levels ranged from 22.0 mg/dL to 1170.3
ug/L. Elevated urine mercury levels also have been detected in some
persons who did not use the cream but who were close household
contacts of cream users. For example, in one sibling of a cream
user, the urine mercury level was 27.7 ug/L even though he had
never used the product. Similarly, in a woman who had not used the
cream herself but whose daughter had used the cream for 1 1/2
years, the urine mercury level was 31.6 ug/L, and in a son of a
cream user, the urine mercury level was 50 ug/L. Persons with
elevated urine mercury levels have been advised by health
departments to consult their physicians.
Reported by: J Villanacci, PhD, R Beauchamp, MD, DM Perrotta, PhD,
Bur of Epidemiology; M Rodriguez, MD, A Abel, Office of Border
Health; RJ Dutton, PhD, Environmental and Consumer Health; DM
Simpson, MD, State Epidemiologist, Texas Dept of Health. F Crespin,
MD, Public Health Div; RE Voorhees, MD, CM Sewell, DrPH, State
Epidemiologist, New Mexico Dept of Health. L Bland, MPH, B Hasty,
MD, R England, MD, State Epidemiologist, Arizona Dept of Health
Svcs. LS Gresham, PhD, MM Ginsberg, MD, A Maroufi, MPH, M Bartzen,
San Diego County Health Dept, San Diego; D Gilliss, MD, S McNeel,
DVM, Environmental Health Investigation Br; S Waterman, MD, State
Epidemiologist, California State Dept of Health Svcs. MG Lombera,
MD, Director General of Epidemiology, Ministry of Health, Mexico.
State Br, Div of Applied Public Health Training (proposed),
Epidemiology Program Office; Health Studies Br, Div of
Environmental Hazards and Health Effects, National Center for
Environmental Health, CDC.
Editorial Note
Editorial Note: The product associated with the cases described in
this report lists calomel as an ingredient but does not state its
concentration. Because mercury compounds are readily absorbed
through intact skin, FDA regulations restrict the use of these
compounds as cosmetic ingredients: specifically, mercury compounds
can be used only as preservatives in eye-area cosmetics at
concentrations not exceeding 65 ppm (0.0065%) of mercury; no
effective and safe nonmercurial substitute preservative is
available for use in such cosmetics. *
The early clinical manifestations of mercury toxicity can be
nonspecific and may be misdiagnosed in users of this or other
products that contain calomel; mercury toxicity should be
considered in cases of neurologic symptoms of unclear etiology.
Chronic exposure to mercury salts can result in a variety of
manifestations of central nervous system toxicity, including
personality changes; nervousness; irritability; tremors; weakness;
fatigue; loss of memory; peripheral neuropathy; mental illness,
including psychosis; and changes in or loss of hearing, vision, or
taste (2). Other classic signs of toxicity associated with exposure
to mercury salts include gingivitis, stomatitis, and excessive
salivation. In children, mercury toxicity may result in the rare
syndrome of acrodynia, which is characterized by severe leg cramps,
irritability, paresthesia, excessive perspiration, pruritus, and
painful redness and peeling of the palms of the hands and soles of
the feet.
The ADHS, CSDHS, NMDH, and TDH have issued public warnings
about and advised discontinuing use of "Crema de Belleza --
Manning."
Persons concerned about mercury exposure should consult their
physicians. Health-care providers should consider mercury poisoning
when assessing illness in persons who have used the cream and
should report cases of exposure to the state or county health
department. Physicians who have questions about the medical
management of patients exposed to mercury should contact their
local poison-control center. Health departments in each of the four
border states can be contacted for specific recommendations
regarding the appropriate disposal of the product.
Although the potential health risks associated with using
"Crema de Belleza -- Manning" were only recognized in 1996, the
cream has been produced since 1971. The prevalence of current use
of this cream cannot be accurately estimated; however, the ongoing
investigation in New Mexico suggests that it is commonly used among
women of childbearing age. In a follow-up survey to assess use of
this product, approximately 2% of women at three Special
Supplemental Nutrition Program for Women, Infants, and Children
clinics in the southern part of New Mexico reported using the
cream. In New Mexico, another skin-care product, "Nutrapiel
Cremaning Plus", made in Tampico, Mexico, recently has been found
to contain 9.7% mercury by weight; other mercury-containing
skin-care products may be identified as a result of this
investigation. Health-education messages should emphasize the
health risks of using any product containing calomel.
FDA has issued a statement about the health risk associated with
use of "Crema de Belleza -- Manning (3)."
References
CDC. Mercury poisoning associated with beauty cream -- Texas,
New
Mexico, and California, 1995-1996. MMWR 1996;45:400-3.
Agency for Toxic Substances and Disease Registry. Toxicological
profile for mercury. Atlanta, Georgia: US Department of Health
and
Human Services, Public Health Service, Agency for Toxic
Substances
and Disease Registry, May 1993.
Food and Drug Administration. FDA warns consumers not to use
Crema de Belleza {Statement}. Rockville, Maryland: US Department
of
Health and Human Services, Public Health Service, Food and Drug
Administration, July 23, 1996.
21 CFR 700.13.
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