deez nuts
01-27-2005, 01:57 PM
memo from work
We have just released the following alert, concerning Mercury Poisoning Case Linked to Use of “Skin-Lightening” Cream. It is also attached as a Word file.
2005 Health Alert
#3: Mercury Poisoning Case Linked to Use of “Skin-Lightening” Cream
As part of our citywide Health and Nutrition Examination Survey, a 22-year-old woman was identified by the New York City Department of Health and Mental Hygiene (DOHMH) with elevated urine mercury. The patient routinely used a skin-lightening product imported from the Dominican Republic, which was tested and found to contain 6190 ppm mercury.
Five cosmetic products have been identified in NYC stores that list mercury as an ingredient. All were manufactured in the Dominican Republic. Samples of these products are being tested by the US Food and Drug Administration for mercury content, as are six unlabeled imported products.
DOHMH asks medical providers to alert their patients who may be using non-prescription skin lightening creams to the potential for mercury exposure. Providers should urge their patients to stop using and to discard mercury containing products or products that are unlabeled.
Please Distribute to All Clinical Staff in Primary Care, Dermatology, Internal Medicine, Pediatrics, Family Practice, Neurology, Psychiatry, Laboratory Medicine and Emergency Medicine
January 27, 2005
Dear Colleagues,
The New York City Department of Health and Mental Hygiene (DOHMH) identified a case of mercury poisoning in a 22-year-old woman. The patient was a participant in the NYC Health and Nutrition Examination Survey (http://www.ci.nyc.ny.us/html/doh/html/hanes/hanes.html ). After an initially elevated urine mercury test, DOHMH referred the patient to an environmental medicine specialist where she received a neurological examination and provided a urine sample. The level of mercury measured in the sample was 205 ug/L. No clinical symptoms consistent with mercury poisoning were observed. The patient remains under medical observation.
After initial interviews with DOHMH personnel that ruled out exposure from occupational, dietary, medicinal or accidental exposures, DOHMH visited the patient’s residence. A skin lightening cream that was used by the patient included ammoniated mercury on the list of ingredients. This product bore the label Recetas de la Farmacia Normal - Crema Blanqueadora and was brought to the United States by the patient from the Dominican Republic. The product was subsequently tested and found to contain 6190 ppm mercury. FDA regulations permit only trace amounts (less than 1 ppm) of mercury in products sold in the United States.
DOHMH has determined that similar products are available in New York City stores. These products contain inorganic mercury salts, which include ammoniated mercury, mercuric chloride, mercurous chloride, mercuric oxide, and mercury iodide. The following items obtained from store shelves list mercury among their ingredients. All are manufactured in the Dominican Republic.
Miss Key Crema Blanqueadora
Santa Cream
Dermaline Skin Cream
Jabón Germicida (soap)
In addition, six unlabeled skin lightening products were also identified and will be tested. Skin lightening products are also manufactured in European, African and Asian countries.
DOHMH recommends that New Yorkers immediately cease using all skin lightening creams and soaps that list mercury as an ingredient, as well as any cosmetic products that do not have a list of ingredients on the label.
DOHMH further recommends that medical providers discuss the possibility of mercury exposure with their patients who may be using non-prescription skin lightening creams or acne treatments. Patients reporting the use of mercury containing products should be evaluated for symptoms consistent with mercury exposure. Twenty-four hour urine, or spot urine tests and blood mercury can be ordered to verify and evaluate exposure and to determine a course of treatment. Urine levels 20 ug/L or higher, and blood levels 5 ug/L or higher must be reported to the New York City Poison Control Center (800-222-1222).
Symptoms and Health Effects of Inorganic Mercury Poisoning The symptoms of acute dermal exposure to inorganic mercury may include graying of skin and skin irritation, and central nervous system symptoms of tremor and erethism (labile personality). Exposure to mercury has been shown to affect the fetus and increase the risk of spontaneous abortion. Inorganic mercury may also be passed to infants in breast milk from a nursing mother. Human case studies and animal studies suggest effects of chronic exposure may include skin sensitization, gastrointestinal symptoms, tremor, erethism and neurasthenia. Inorganic mercury mostly accumulates in the kidney and chronic poisoning may result cause in renal dysfunction.
Mercury exposure may also occur from the metallic form, usually from vapor from broken thermometers, thermostats and other equipment. People are also exposed to methyl-mercury from dietary sources, especially from fish from contaminated waters or large fish high on the food chain like albacore and bluefin tuna, shark and swordfish.
Medical Testing
Twenty-four hour urine sampling is the preferred testing standard for inorganic mercury, however spot urine and blood may also used to detect exposure. Urines should be analyzed by New York State certified laboratories. To find a certified laboratory, call 518-485-5378 or visit http://www.wadsworth.org/labcert/clep/CategoryPermitLinks/CategoryListing.htm.
Medical Treatment
The most appropriate treatment for inorganic mercury poisoning is to eliminate the source of exposure by terminating use of mercury contaminated products. The half-life of inorganic mercury in the body is estimated at approximately 30-60 days. Patients with elevated mercury should be retested monthly. Initation of chelation therapy may be considered in cases where there are significant symptoms and a history of prolonged exposure.
Environmental Decontamination
DOHMH recommends that mercury-containing skin products in the household be sealed in plastic bags and discarded with household trash. Stores which may stock these products are urged to contact 311 to have DOHMH collect them. A press release on this issue is also available at http://www.nyc.gov/html/doh/html/public/press05/press05.html
As always, we appreciate your continued collaboration with our efforts to monitor illness in New York City. For more information about mercury exposure and treatment of mercury poisoning, contact the New York City Poison Control Center at 1-800-222-1222.
Sincerely,
Jessica Leighton, PhD, MPH
Assistant Commissioner
Bureau of Environmental Disease Prevention
We have just released the following alert, concerning Mercury Poisoning Case Linked to Use of “Skin-Lightening” Cream. It is also attached as a Word file.
2005 Health Alert
#3: Mercury Poisoning Case Linked to Use of “Skin-Lightening” Cream
As part of our citywide Health and Nutrition Examination Survey, a 22-year-old woman was identified by the New York City Department of Health and Mental Hygiene (DOHMH) with elevated urine mercury. The patient routinely used a skin-lightening product imported from the Dominican Republic, which was tested and found to contain 6190 ppm mercury.
Five cosmetic products have been identified in NYC stores that list mercury as an ingredient. All were manufactured in the Dominican Republic. Samples of these products are being tested by the US Food and Drug Administration for mercury content, as are six unlabeled imported products.
DOHMH asks medical providers to alert their patients who may be using non-prescription skin lightening creams to the potential for mercury exposure. Providers should urge their patients to stop using and to discard mercury containing products or products that are unlabeled.
Please Distribute to All Clinical Staff in Primary Care, Dermatology, Internal Medicine, Pediatrics, Family Practice, Neurology, Psychiatry, Laboratory Medicine and Emergency Medicine
January 27, 2005
Dear Colleagues,
The New York City Department of Health and Mental Hygiene (DOHMH) identified a case of mercury poisoning in a 22-year-old woman. The patient was a participant in the NYC Health and Nutrition Examination Survey (http://www.ci.nyc.ny.us/html/doh/html/hanes/hanes.html ). After an initially elevated urine mercury test, DOHMH referred the patient to an environmental medicine specialist where she received a neurological examination and provided a urine sample. The level of mercury measured in the sample was 205 ug/L. No clinical symptoms consistent with mercury poisoning were observed. The patient remains under medical observation.
After initial interviews with DOHMH personnel that ruled out exposure from occupational, dietary, medicinal or accidental exposures, DOHMH visited the patient’s residence. A skin lightening cream that was used by the patient included ammoniated mercury on the list of ingredients. This product bore the label Recetas de la Farmacia Normal - Crema Blanqueadora and was brought to the United States by the patient from the Dominican Republic. The product was subsequently tested and found to contain 6190 ppm mercury. FDA regulations permit only trace amounts (less than 1 ppm) of mercury in products sold in the United States.
DOHMH has determined that similar products are available in New York City stores. These products contain inorganic mercury salts, which include ammoniated mercury, mercuric chloride, mercurous chloride, mercuric oxide, and mercury iodide. The following items obtained from store shelves list mercury among their ingredients. All are manufactured in the Dominican Republic.
Miss Key Crema Blanqueadora
Santa Cream
Dermaline Skin Cream
Jabón Germicida (soap)
In addition, six unlabeled skin lightening products were also identified and will be tested. Skin lightening products are also manufactured in European, African and Asian countries.
DOHMH recommends that New Yorkers immediately cease using all skin lightening creams and soaps that list mercury as an ingredient, as well as any cosmetic products that do not have a list of ingredients on the label.
DOHMH further recommends that medical providers discuss the possibility of mercury exposure with their patients who may be using non-prescription skin lightening creams or acne treatments. Patients reporting the use of mercury containing products should be evaluated for symptoms consistent with mercury exposure. Twenty-four hour urine, or spot urine tests and blood mercury can be ordered to verify and evaluate exposure and to determine a course of treatment. Urine levels 20 ug/L or higher, and blood levels 5 ug/L or higher must be reported to the New York City Poison Control Center (800-222-1222).
Symptoms and Health Effects of Inorganic Mercury Poisoning The symptoms of acute dermal exposure to inorganic mercury may include graying of skin and skin irritation, and central nervous system symptoms of tremor and erethism (labile personality). Exposure to mercury has been shown to affect the fetus and increase the risk of spontaneous abortion. Inorganic mercury may also be passed to infants in breast milk from a nursing mother. Human case studies and animal studies suggest effects of chronic exposure may include skin sensitization, gastrointestinal symptoms, tremor, erethism and neurasthenia. Inorganic mercury mostly accumulates in the kidney and chronic poisoning may result cause in renal dysfunction.
Mercury exposure may also occur from the metallic form, usually from vapor from broken thermometers, thermostats and other equipment. People are also exposed to methyl-mercury from dietary sources, especially from fish from contaminated waters or large fish high on the food chain like albacore and bluefin tuna, shark and swordfish.
Medical Testing
Twenty-four hour urine sampling is the preferred testing standard for inorganic mercury, however spot urine and blood may also used to detect exposure. Urines should be analyzed by New York State certified laboratories. To find a certified laboratory, call 518-485-5378 or visit http://www.wadsworth.org/labcert/clep/CategoryPermitLinks/CategoryListing.htm.
Medical Treatment
The most appropriate treatment for inorganic mercury poisoning is to eliminate the source of exposure by terminating use of mercury contaminated products. The half-life of inorganic mercury in the body is estimated at approximately 30-60 days. Patients with elevated mercury should be retested monthly. Initation of chelation therapy may be considered in cases where there are significant symptoms and a history of prolonged exposure.
Environmental Decontamination
DOHMH recommends that mercury-containing skin products in the household be sealed in plastic bags and discarded with household trash. Stores which may stock these products are urged to contact 311 to have DOHMH collect them. A press release on this issue is also available at http://www.nyc.gov/html/doh/html/public/press05/press05.html
As always, we appreciate your continued collaboration with our efforts to monitor illness in New York City. For more information about mercury exposure and treatment of mercury poisoning, contact the New York City Poison Control Center at 1-800-222-1222.
Sincerely,
Jessica Leighton, PhD, MPH
Assistant Commissioner
Bureau of Environmental Disease Prevention