Mercury Poisoning Associated with Beauty Cream -- Texas, New Mexico, and California, 1995-1996

The Texas Department of Health (TDH), New Mexico Department of Health (NMDH), and San Diego County Health Department (SDCHD) recently investigated three cases of mercury poisoning among persons who had used a beauty cream produced in Mexico. The investigations implicated the beauty cream as the source of the mercury. The cream, marketed as "Crema de Belleza -- Manning," lists "calomel" (mercurous chloride) as an ingredient and was found to contain 6%-8% mercury by weight. This report summarizes the ongoing investigation of these and other possible cases. Case 1

In September 1995, a previously healthy 15-year-old boy who resided in Texas near the Mexico border had onset of fatigue, weakness, insomnia, myalgias of his extremities, severe headache, sore throat, cough, constipation, and paresthesias of his feet and hands. On September 16, a physician in Piedras Negras, Mexico, prescribed symptomatic treatment for the paresthesia and cough. Subsequent problems included loss of taste, weight loss of approximately 15 pounds, and progressive weakness in his arms and legs. A neurologist in Piedras Negras performed an electromyogram and measured nerve-conduction velocities that were consistent with a demyelinating polyneuropathy.

In early November 1995, the patient was evaluated at a hospital in San Antonio, Texas, where a magnetic resonance imaging (MRI) scan of his brain was normal. Findings on examination by a pediatric neurologist included intact cranial nerve function, diffusely decreased deep tendon reflexes, and mild weakness of the lower extremities. On November 3, his blood lead and urine arsenic levels were normal; however, a urine mercury level was 178 ug/L (normal range: 0-20 ug/L), and chelation therapy was initiated on December 7.

TDH conducted an environmental assessment of the patient's home in mid-December and did not detect mercury in indoor air, indoor paint, or soil. Family members reported that they ate fish from Mexico once or twice per year and denied hobbies at home or school known to be associated with mercury exposure. However, a container of cream ("Crema de Belleza -- Manning") that was used regularly by the patient for treatment of acne had "calomel" listed as an ingredient. Elevated mercury levels (approximately 6% by weight) were confirmed in that container and in a second previously unopened container of the cream. The patient had been using the cream daily since June and was advised to discontinue use. Case 2

In April 1996, a neurologist in El Paso, Texas, diagnosed mercury poisoning in a 35-year-old woman who resided in New Mexico; urinary mercury levels were 355 ug/g creatinine (normal: 0-25 ug/g creatinine). Beginning in September 1995, the patient had onset of symptoms progressing to paresthesias (left forearm, right leg, and ear), irritability, and insomnia by March 1996. A collaborative investigation by the NMDH and TDH indicated that the woman had used "Crema de Belleza -- Manning" for approximately 10 years and had no other known exposures to mercury. She was immediately advised to discontinue use of the cream. Case 3

On May 7, 1996, SDCHD identified mercury poisoning in a 33-year-old woman who resided in San Diego, California; urinary mercury levels were 143 ug/g creatinine. During 1992-1996, the woman had had weekly severe migraine headaches of 3-4 days' duration, irritability, fatigue, short-term memory loss, night blindness, and inability to eat products from tin cans because of overt metal taste. Since 1990, the patient had been using "Creme de Belleza -- Manning" daily on her face, hands, and chest and had no other known exposures to mercury. She was immediately advised to discontinue use of the cream. Follow-Up Investigation and Control Measures

TDH and the California Department of Health Services (CDHS) are investigating additional cases of possible mercury poisoning related to the use of "Crema de Belleza -- Manning." On April 19, TDH issued press releases recommending that persons discontinue use of "Crema de Belleza -- Manning" and that persons with potential manifestations of mercury poisoning or who were exposed to the product consult their physicians. Physicians were advised to contact local poison-control centers regarding the medical management of patients exposed to mercury. In addition, because the cream is considered hazardous waste, TDH recommends that cream be disposed of in a manner consistent with the proper disposal of hazardous household waste such as batteries or paint. CDHS will issue similar recommendations. For disposal instructions, commercial retailers with remaining stock can contact Paul Thomas, U.S. Environmental Protection Agency, telephone (214) 665-6707.

During April 22-30, 1996, the Mexican Secretary of Health seized 35,000 containers of "Crema de Belleza -- Manning" in the State of Tampaulipas, Mexico, for testing at the National Public Health Laboratory. Laboratory analyses confirmed high levels of mercury (approximately 8% by weight) in the cream. As a result, the Mexican Secretary of Health issued an epidemiologic alert to all northern border states of Mexico to enhance surveillance for cases of acute or chronic mercury intoxication.

Reported by: JF Villanacci, PhD, R Beauchamp, MD, DM Perrotta, PhD, Bur of Epidemiology; K Hendricks, MD, Bur of Communicable Disease Control; M Rodriguez, MD, Office of Border Health; RJ Dutton, PhD, Environmental and Consumer Health; K Sutton, MS, Public Health Region 8; J Duran, Public Health Region 9/10; DM Simpson, MD, State Epidemiologist, Texas Dept of Health. K Richards, Office of Border Health; D Nelson, Div of Epidemiology, Evaluation, and Planning; F Crespin, MD, Public Health Div; CM Sewell, DrPh, State Epidemiologist, New Mexico Dept of Health. M Bartzen, M Ginsberg, MD, San Diego County Health Dept, San Diego; L Senini, Office of Border Health, F Nava, S Richardson, S Waterman, MD, State Epidemiologist, California Dept of Health Svcs. MG Lombera, MD, MA Ruiz, MD, P Cravioto, MS, Director General of Epidemiology, Ministry of Health; O Saldate, National Laboratory of Public Health, Ministry of Health; G Flores, MD, Health Svcs of Tampaulipas, Mexico. Environmental Hazards Epidemiology Section, Health Studies Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health; Div of Field Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Although the product associated with these three reported cases of mercury poisoning is sold primarily in Mexico, the ongoing investigation also is assessing reports that the product may be sold in the United States in some border-area shops. Furthermore, some U.S. residents residing in the border-area frequently travel to Mexico to purchase pharmaceuticals for use in the United States.

The product label is printed in Spanish and lists "calomel" (i.e., mercurous chloride) as an ingredient, but does not indicate the concentration. Because mercury compounds are readily absorbed through the skin, Food and Drug Administration regulations restrict the use of these compounds as cosmetic ingredients: specifically, mercury can be used only as a preservative in eye-area cosmetics at concentrations not exceeding 65 ppm (0.0065%); no effective and safe nonmercurial substitute preservative is available for use in such cosmetics. *

Urinary mercury concentrations greater than 20 ug/L or greater than 25 ug/g creatinine have been associated with signs and symptoms of mercury poisoning. Chronic exposure to mercury salts can result in central nervous system toxicity, including personality changes; nervousness; irritability; tremors; weakness; fatigue; loss of memory; changes in or loss of hearing, vision, or taste (1); gingivitis; stomatitis; and excessive salivation. In children, mercury poisoning can result in the syndrome of acrodynia, which is characterized by severe leg cramps, irritability, paresthesias, excessive perspiration, pruritus, and painful redness and peeling of the palms of the hands and soles of the feet. Acute poisoning with mercury salts can result in a metallic taste, nausea, vomiting, bloody diarrhea, severe abdominal pain, and tenesmus. Renal damage may include acute tubular necrosis and excessive protein, casts, and red blood cells in the urine. Additional information about mercury poisoning is available from local poison-control centers.

Reference

1. 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 Diseases Registry, May 1993.

• 21 CFR 700.13.

  
  
  

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