Percutaneous mercury poisoning with a beauty cream in Mexico
2001; Elsevier BV; Volume: 45; Issue: 6 Linguagem: Inglês
10.1067/mjd.2001.l17243
ISSN1097-6787
AutoresAlberto Tlacuilo‐Parra, Elizabeth Guevara-Gutirrez, Jos Angel Luna-Encinas,
Tópico(s)Porphyrin Metabolism and Disorders
ResumoTo the Editor:The practice of applying mercurial preparations to the skin has been accepted for almost 500 years.1Cole HN Schreiber N Sollman T Mercurial ointments in the treatment of syphilis.Arch Dermatol. 1930; 21: 372-393Crossref Scopus (17) Google Scholar There have been reports of mercury poisoning occurring after the cutaneous applications of products such as soaps,2Lauwerys R Bonnier CH Evrard PH Gennart JP Bernard A Prenatal and early postnatal intoxication by inorganic mercury resulting from the maternal use of mercury containing soap.Hum Toxicol. 1987; 6: 253-256Crossref PubMed Scopus (51) Google Scholar creams,3Barr RD Woodger BM Ress PH Levels of mercury in urine correlated with the use of skin lightening creams.Am J Clin Pathol. 1973; 59: 36-40PubMed Google Scholar and ointments.4Kern F Roberts L Ostlere L Langtry J Staughton RCD Ammoniated mercury ointment as a cause of peripheral neuropathy.Dermatologica. 1991; 183: 280-282Crossref PubMed Scopus (19) Google Scholar This letter summarizes the findings of a patient who was referred with clinical suspicion of systemic lupus erythematosus, who finally was found to be poisoned with a beauty cream, marketed as "Crema de Belleza-Manning."A 30-year-old woman presented in 1996 with malar rash, burning pain on the face exacerbated by sunlight, and excessive perspiration; in 1997 she had several episodes of sudden flushing that progressively faded within an hour, as well as erythema of the palms and soles and intentional tremor; and in 1998 she suffered from sialorrhea, pruritus, emotional lability, weakness, and insomnia. She had been seen before by many specialists and was referred for evaluation under the suspicion of systemic lupus erythematosus. On physical examination, vital signs were normal; abnormal findings consisted of erythema and telangiectases in a malar distribution, hypersalivation, tightness, and erythema on the palms and soles, as well as tremors and weakness. Results of a neuropsychiatric examination were normal. Laboratory test results were unremarkable; in particular, they were negative for antinuclear antibodies, rheumatoid factor, and antibodies to double-stranded DNA.An extensive investigation revealed that the patient had used "Crema de Belleza-Manning" for daily facial skin cleansing for approximately 5 years. The presence of multiple heavy metals was determined using inductively coupled plasma spectrometry (Spectro Analytical Instruments Inc, Fitchburg. Mass) on the sediment of an old container of the cream.5al-Saleh I al-Doush I Mercury content in skin-lightening creams and potential hazards to the health of Saudi women.J Toxicol Environ Health. 1997; 51: 123-130PubMed Google Scholar Elevated mercury levels (221,000 parts per million [ppm]) were confirmed, a 24-hour urine mercury level was 150 μg/L (normal range, 0-20 μg/L), whole blood Hg was 30 μg/L (normal range, <14.9 μg/L), which confirmed mercury poisoning; cessation of cream use and chelation therapy with penicillamine were initiated. The symptoms resolved slowly.The product associated with this case listed "calomel" (mercurous chloride) as an ingredient, but its concentration was not stated.6Centers for Disease Control Mercury poisoning associated with beauty cream: Texas, New Mexico, and California, 1995-1996.MMWR. 1996; 45: 400-403PubMed Google Scholar Because mercury compounds are readily absorbed through intact skin, Food and Drug Administration regulations7Centers for Disease Control Mercury poisoning associated with beauty cream: Arizona, California, New Mexico and Texas, 1996.MMWR. 1996; 45: 633-635PubMed Google Scholar restrict the use of these compounds only as preservatives in cosmetics for the eye area at concentrations not exceeding 65 ppm (cream contained 221,000 ppm). Althought the product is sold primarily in Mexico, some US residents residing in the border area frequently travel to Mexico to purchase pharmaceuticals.8McRill C Boyer LV Flood TJ Ortega L Mercury toxicity due to use of a cosmetic cream.J Occup Environ Med. 2000; 42: 4-7Crossref PubMed Scopus (42) Google Scholar, 9Weldon MM Smolinski MS Maroufi A Hasty BW Gilliss DL Boulanger LL et al.Mercury poisoning associated with a Mexican beauty cream.West J Med. 2000; 173: 15-18Crossref PubMed Scopus (86) Google Scholar Mercury toxicity should be considered in cases of dermatologic and neurologic symptoms of unclear origin associated with the use of this product. To the Editor:The practice of applying mercurial preparations to the skin has been accepted for almost 500 years.1Cole HN Schreiber N Sollman T Mercurial ointments in the treatment of syphilis.Arch Dermatol. 1930; 21: 372-393Crossref Scopus (17) Google Scholar There have been reports of mercury poisoning occurring after the cutaneous applications of products such as soaps,2Lauwerys R Bonnier CH Evrard PH Gennart JP Bernard A Prenatal and early postnatal intoxication by inorganic mercury resulting from the maternal use of mercury containing soap.Hum Toxicol. 1987; 6: 253-256Crossref PubMed Scopus (51) Google Scholar creams,3Barr RD Woodger BM Ress PH Levels of mercury in urine correlated with the use of skin lightening creams.Am J Clin Pathol. 1973; 59: 36-40PubMed Google Scholar and ointments.4Kern F Roberts L Ostlere L Langtry J Staughton RCD Ammoniated mercury ointment as a cause of peripheral neuropathy.Dermatologica. 1991; 183: 280-282Crossref PubMed Scopus (19) Google Scholar This letter summarizes the findings of a patient who was referred with clinical suspicion of systemic lupus erythematosus, who finally was found to be poisoned with a beauty cream, marketed as "Crema de Belleza-Manning."A 30-year-old woman presented in 1996 with malar rash, burning pain on the face exacerbated by sunlight, and excessive perspiration; in 1997 she had several episodes of sudden flushing that progressively faded within an hour, as well as erythema of the palms and soles and intentional tremor; and in 1998 she suffered from sialorrhea, pruritus, emotional lability, weakness, and insomnia. She had been seen before by many specialists and was referred for evaluation under the suspicion of systemic lupus erythematosus. On physical examination, vital signs were normal; abnormal findings consisted of erythema and telangiectases in a malar distribution, hypersalivation, tightness, and erythema on the palms and soles, as well as tremors and weakness. Results of a neuropsychiatric examination were normal. Laboratory test results were unremarkable; in particular, they were negative for antinuclear antibodies, rheumatoid factor, and antibodies to double-stranded DNA.An extensive investigation revealed that the patient had used "Crema de Belleza-Manning" for daily facial skin cleansing for approximately 5 years. The presence of multiple heavy metals was determined using inductively coupled plasma spectrometry (Spectro Analytical Instruments Inc, Fitchburg. Mass) on the sediment of an old container of the cream.5al-Saleh I al-Doush I Mercury content in skin-lightening creams and potential hazards to the health of Saudi women.J Toxicol Environ Health. 1997; 51: 123-130PubMed Google Scholar Elevated mercury levels (221,000 parts per million [ppm]) were confirmed, a 24-hour urine mercury level was 150 μg/L (normal range, 0-20 μg/L), whole blood Hg was 30 μg/L (normal range, <14.9 μg/L), which confirmed mercury poisoning; cessation of cream use and chelation therapy with penicillamine were initiated. The symptoms resolved slowly.The product associated with this case listed "calomel" (mercurous chloride) as an ingredient, but its concentration was not stated.6Centers for Disease Control Mercury poisoning associated with beauty cream: Texas, New Mexico, and California, 1995-1996.MMWR. 1996; 45: 400-403PubMed Google Scholar Because mercury compounds are readily absorbed through intact skin, Food and Drug Administration regulations7Centers for Disease Control Mercury poisoning associated with beauty cream: Arizona, California, New Mexico and Texas, 1996.MMWR. 1996; 45: 633-635PubMed Google Scholar restrict the use of these compounds only as preservatives in cosmetics for the eye area at concentrations not exceeding 65 ppm (cream contained 221,000 ppm). Althought the product is sold primarily in Mexico, some US residents residing in the border area frequently travel to Mexico to purchase pharmaceuticals.8McRill C Boyer LV Flood TJ Ortega L Mercury toxicity due to use of a cosmetic cream.J Occup Environ Med. 2000; 42: 4-7Crossref PubMed Scopus (42) Google Scholar, 9Weldon MM Smolinski MS Maroufi A Hasty BW Gilliss DL Boulanger LL et al.Mercury poisoning associated with a Mexican beauty cream.West J Med. 2000; 173: 15-18Crossref PubMed Scopus (86) Google Scholar Mercury toxicity should be considered in cases of dermatologic and neurologic symptoms of unclear origin associated with the use of this product. The practice of applying mercurial preparations to the skin has been accepted for almost 500 years.1Cole HN Schreiber N Sollman T Mercurial ointments in the treatment of syphilis.Arch Dermatol. 1930; 21: 372-393Crossref Scopus (17) Google Scholar There have been reports of mercury poisoning occurring after the cutaneous applications of products such as soaps,2Lauwerys R Bonnier CH Evrard PH Gennart JP Bernard A Prenatal and early postnatal intoxication by inorganic mercury resulting from the maternal use of mercury containing soap.Hum Toxicol. 1987; 6: 253-256Crossref PubMed Scopus (51) Google Scholar creams,3Barr RD Woodger BM Ress PH Levels of mercury in urine correlated with the use of skin lightening creams.Am J Clin Pathol. 1973; 59: 36-40PubMed Google Scholar and ointments.4Kern F Roberts L Ostlere L Langtry J Staughton RCD Ammoniated mercury ointment as a cause of peripheral neuropathy.Dermatologica. 1991; 183: 280-282Crossref PubMed Scopus (19) Google Scholar This letter summarizes the findings of a patient who was referred with clinical suspicion of systemic lupus erythematosus, who finally was found to be poisoned with a beauty cream, marketed as "Crema de Belleza-Manning." A 30-year-old woman presented in 1996 with malar rash, burning pain on the face exacerbated by sunlight, and excessive perspiration; in 1997 she had several episodes of sudden flushing that progressively faded within an hour, as well as erythema of the palms and soles and intentional tremor; and in 1998 she suffered from sialorrhea, pruritus, emotional lability, weakness, and insomnia. She had been seen before by many specialists and was referred for evaluation under the suspicion of systemic lupus erythematosus. On physical examination, vital signs were normal; abnormal findings consisted of erythema and telangiectases in a malar distribution, hypersalivation, tightness, and erythema on the palms and soles, as well as tremors and weakness. Results of a neuropsychiatric examination were normal. Laboratory test results were unremarkable; in particular, they were negative for antinuclear antibodies, rheumatoid factor, and antibodies to double-stranded DNA. An extensive investigation revealed that the patient had used "Crema de Belleza-Manning" for daily facial skin cleansing for approximately 5 years. The presence of multiple heavy metals was determined using inductively coupled plasma spectrometry (Spectro Analytical Instruments Inc, Fitchburg. Mass) on the sediment of an old container of the cream.5al-Saleh I al-Doush I Mercury content in skin-lightening creams and potential hazards to the health of Saudi women.J Toxicol Environ Health. 1997; 51: 123-130PubMed Google Scholar Elevated mercury levels (221,000 parts per million [ppm]) were confirmed, a 24-hour urine mercury level was 150 μg/L (normal range, 0-20 μg/L), whole blood Hg was 30 μg/L (normal range, <14.9 μg/L), which confirmed mercury poisoning; cessation of cream use and chelation therapy with penicillamine were initiated. The symptoms resolved slowly. The product associated with this case listed "calomel" (mercurous chloride) as an ingredient, but its concentration was not stated.6Centers for Disease Control Mercury poisoning associated with beauty cream: Texas, New Mexico, and California, 1995-1996.MMWR. 1996; 45: 400-403PubMed Google Scholar Because mercury compounds are readily absorbed through intact skin, Food and Drug Administration regulations7Centers for Disease Control Mercury poisoning associated with beauty cream: Arizona, California, New Mexico and Texas, 1996.MMWR. 1996; 45: 633-635PubMed Google Scholar restrict the use of these compounds only as preservatives in cosmetics for the eye area at concentrations not exceeding 65 ppm (cream contained 221,000 ppm). Althought the product is sold primarily in Mexico, some US residents residing in the border area frequently travel to Mexico to purchase pharmaceuticals.8McRill C Boyer LV Flood TJ Ortega L Mercury toxicity due to use of a cosmetic cream.J Occup Environ Med. 2000; 42: 4-7Crossref PubMed Scopus (42) Google Scholar, 9Weldon MM Smolinski MS Maroufi A Hasty BW Gilliss DL Boulanger LL et al.Mercury poisoning associated with a Mexican beauty cream.West J Med. 2000; 173: 15-18Crossref PubMed Scopus (86) Google Scholar Mercury toxicity should be considered in cases of dermatologic and neurologic symptoms of unclear origin associated with the use of this product.
Referência(s)