What causes face cream toxicity?
January 5, 2024
A 39-year-old female who emigrated from Afghanistan six months ago presents with the complaint of fatigue. She has a history of DM, nephrotic syndrome, and a recent diagnosis of peripheral neuropathy. She does not have her meds with her and denies taking supplements. Initial ED workup reveals lower extremity edema, significant proteinuria, and slightly elevated creatinine. Subsequent nephrology consult included a kidney biopsy which reveals membranous nephropathy (MN is an autoimmune disease characterized by a thickening of the glomerular capillary walls due to immune complex deposition. Can present with proteinuria, peripheral edema, frothy urine).
What toxicants should be considered with a peripheral neuropathy and glomerular disease?
Answer: Certainly there are many pharmaceutical agents that may cause this pattern of disease such as clopidogrel, gold and D-penicillamine, Lithium, NSAIDS and COX2 inhibitors, tiopronin. Patient denied taking any of these medications. However, other toxicants that must be considered include heavy metals such as lead and mercury.
Workup:
Serum Hg: 19.2 mcg/L (way too high)
Urine Hg: 47.7 mcg/L
Whole blood lead level: negative
Where could this patient have access to mercury when she denied taking any medicinal agents or supplements? The patient was using Golden Pearl Beauty Cream, which is a skin lightening agent that contains 12,000ppm of Hg in the product.
Why would mercury be in a skin lightening cream? Because it works. Mercury inhibits melanin production, resulting in a lighter skin tone. However, mercury is absorbed through the skin and with repeated topical applications, systemic absorption and toxicity can occur.
The cream was discontinued and patient was not chelated. Serum and urine Hg rapidly decreased just by discontinuing the cream. Regarding chelation- a number of toxicologists disagreed on whether it was indicated. This is complicated beyond the scope of this Question.
Ref to consider:
Chan TYK, Chan APL, Tang HL Nephrotic syndrome caused by skin lightening creams containing inorganic mercury. Clin Toxicol (Phila). 2020 Jan;58(1):9-15. doi: 10.1080/15563650.2019.1639724. Epub 2019 Jul 17.PMID: 31314603 Review.
Li SJ, Zhang SH, Chen HP, Zeng CH, Zheng CX, Li LS, Liu ZH. Mercury-induced membranous nephropathy: clinical and pathological features.Clin J Am Soc Nephrol. 2010 Mar;5(3):439-44. doi: 10.2215/CJN.07571009. Epub 2010 Jan 14.PMID: 20089494
Question prepared by Donna Seger MD
Discussion: Asking the patient if they take supplements is routine, but beauty products are not considered supplements, even by clinicians. Face creams and other cosmetics, which can be obtained over the internet or brought from other countries, may contain either lead or mercury. Don’t forget about the face creams. ds
I am interested in any questions you would like answered in the Question of the Week. Please email me with any suggestions at donna.seger@vumc.org.
Donna Seger, MD
Professor Emerita
Department of Medicine
VUMC