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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

  1. CDC. Mercury poisoning associated with beauty cream -- Texas, New Mexico, and California, 1995-1996. MMWR 1996;45:400-3.

  2. 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.

  3. 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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