Mercury Toxicity and Contamination of Households from the Use of Skin Creams Adulterated with Mercurous Chloride (Calomel)

Our evolved understanding of the human health risks of mercury

Mercury (Hg) is a chemical of health concern worldwide that is now being acted upon through the Minamata Convention. Operationalizing the Convention and tracking its effectiveness requires empathy of the diversity and variation of mercury exposure and risk in populations worldwide. As part of the health plenary for the 15th International Conference on Mercury as a Global Pollutant (ICMGP), this review paper details how scientific understandings have evolved over time, from tragic poisoning events in the mid-twentieth century to important epidemiological studies in the late-twentieth century in the Seychelles and Faroe Islands, the Arctic and Amazon. Entering the twenty-first century, studies on diverse source-exposure scenarios (e.g., ASGM, amalgams, contaminated sites, cosmetics, electronic waste) from across global regions have expanded understandings and exemplified the need to consider socio-environmental variables and local contexts when conducting health studies. We conclude with perspectives on next steps for mercury health research in the post-Minamata Convention era.

Differences in personal care product use by race/ethnicity among women in California: implications for chemical exposures

BACKGROUND

Personal care products may contain many chemicals, some of which are suspected endocrine disrupters. This is an important source of chemical exposure for women, but little is known about how chemical exposure differs among different races/ethnicities.

OBJECTIVE

This study examines differences in personal care product use among Black, Latina, Vietnamese, Mixed Race, and White women in California.

METHODS

We used a community-based participatory process to create and administer a personal care product usage survey to 321 Black, Latina, Vietnamese, Mixed Race, and White women. We used multivariate regression models with pairwise comparisons to examine the frequency of product use by race/ethnicity.

RESULTS

We found distinct trends of personal care product use by race/ethnicity: Latina women typically used makeup most frequently; Black women used certain hair products or styles most frequently; and Vietnamese women were most likely to use facial cleansing products compared to other races/ethnicities. Latina and Vietnamese women were less likely to try to avoid certain ingredients in their products.

SIGNIFICANCE

These findings can help estimate disparities in chemical exposure from personal care product use and complement future research on health inequities due to chemical exposures in the larger environmental and social context.

Adverse health effects of emerging contaminants on inflammatory bowel disease

Inflammatory bowel disease (IBD) is becoming increasingly prevalent with the improvement of people's living standards in recent years, especially in urban areas. The emerging environmental contaminant is a newly-proposed concept in the progress of industrialization and modernization, referring to synthetic chemicals that were not noticed or researched before, which may lead to many chronic diseases, including IBD. The emerging contaminants mainly include microplastics, endocrine-disrupting chemicals, chemical herbicides, heavy metals, and persisting organic pollutants. In this review, we summarize the adverse health effect of these emerging contaminants on humans and their relationships with IBD. Therefore, we can better understand the impact of these new emerging contaminants on IBD, minimize their exposures, and lower the future incidence of IBD.

Occupational exposure to mercury from cinnabar enriched sand in workers of Grado Beach, Gulf of Trieste (North-eastern Italy, upper Adriatic Sea)

Health and safety of occupations entailing extensive skin contact with cinnabar-enriched sand in beaches of Friuli-Venezia Giulia (FVG) Region (North-eastern Italy) have been questioned for possible skin absorption of mercury (Hg). One hundred mg hair was collected from the occipital scalp of 50 male workers of Grado beach and 121 males from FVG general population. Factors associated with hair Hg content were investigated by multivariable logistic (considering Hg levels >1 vs ≤1 mg/kg) and log-transformed linear regression. The median hair concentration of Hg in male beach workers was 0.70 (IQR = 0.42; 1.34) mg/kg, lower than FVG general population's [1.29 (IQR = 0.87-2.06) mg/kg (p < 0.001)]. In both regression models the hair Hg increased with fish consumption, both among beach workers of Grado and FVG general population. The mean Hg levels in beach workers of Grado fell within an acceptable range, not requiring restrictions of their occupational activities.

A Systematic Review of Mercury Exposures from Skin-Lightening Products

BACKGROUND

The Minamata Convention on Mercury (Article 4) prohibits the manufacture, import, or export of skin-lightening products containing mercury concentrations above 1 ppm. However, there is a lack of knowledge surrounding the global prevalence of mercury-added skin-lightening products.

OBJECTIVE

The objective of this study was to increase our understanding of worldwide human mercury exposure from skin-lightening products.

METHODS

A systematic search of peer-reviewed scientific literature was performed for relevant articles in four databases (PubMed, Web of Science Core Collection, Scopus, and TOXLINE). The search strategy, eligibility criteria, and data-extraction methods were established a priori. The search identified 2,303 unique scientific articles, of which 41 were ultimately deemed eligible for inclusion after iterative screens at the title, abstract, and whole-text levels. To facilitate data extraction and synthesis, all papers were organized according to four data groups a) "Mercury in products," b) "Usage of products," c) "Human biomarkers of exposure," and d) "Health impacts."

RESULTS

This review was based on data contained in 41 peer-reviewed scientific papers from 22 countries worldwide published between 2000 and 2022. In total, we captured mercury concentration values from 787 skin-lightening product samples [overall pooled central median mercury level was 0.49μg/g; interquartile range (IQR): 0.02-5.9] and 1,042 human biomarker measurements from 863 individuals. We also synthesized usage information from 3,898 individuals and self-reported health impacts associated with using mercury-added products from 832 individuals.

DISCUSSION

This review suggests that mercury widely exists as an active ingredient in many skin-lightening products worldwide and that users are at risk of variable and often high exposures. These synthesized findings identify data gaps and help increase our understanding of the health risks associated with the use of these products. https://doi.org/10.1289/EHP10808.

DNA Damage and Proteomic Profile Changes in Rat Salivary Glands After Chronic Exposure to Inorganic Mercury

Mercury (Hg) is a toxic metal that became a public health problem due to environmental contamination caused by anthropogenic activity. In this sense, oral homeostasis can undergo changes due to the toxic effects of metal on the salivary glands. Therefore, our objective was to investigate the proteomic and genotoxic changes in salivary glands after exposure to inorganic mercury (IHg). Forty Wistar rats that were divided into a control group, which received distilled water, and an exposed group, which received 0.375 mg/kg of mercury chloride for 45 days via orogastric gavage. After that, the animals were euthanized, and the parotid and submandibular glands were collected for analysis of the genotoxic effects, using the comet assay and proteome global profile assessment. The results showed that IHg promoted damage to cellular DNA associated with proteomic changes that showed events such as oxidative stress, mitochondrial dysfunction, changes in the cytoskeleton, and apoptosis. Therefore, these findings show a profile of molecular changes due to the interactions of IHg with several proteins and mechanisms inherent to the cell, which consequently may result in dysfunction of the salivary glands and impaired homeostasis of the oral cavity.

Spreading of Dangerous Skin-Lightening Products as a Result of Colourism: A Review

The use of bleaching products can have a medical or cosmetic purpose; in the latter case, skin whitening is most widespread in countries where darker skin tones prevail and can be driven by psychosocial, cultural and economic reasons. Skin-whitening products containing highly toxic active ingredients (in particular mercury derivatives, hydroquinone and corticosteroids) are easily found on the market; the use of these depigmenting agents can be followed by a variety of adverse effects, with very serious and sometimes fatal complications, and is currently an emerging health concern in many countries. This article concisely discusses the reasons for the current prevalence of skin lightening products and provides an overview of the skin lightening agents that pose a threat to human health. The review also reports market surveillance data on the circulation of banned skin lighteners in Europe, obtained through the Safety Gate system.

Prenatal metal(loid) mixtures and birth weight for gestational age: A pooled analysis of three cohorts participating in the ECHO program

BACKGROUND

A growing number of studies have identified both toxic and essential metals which influence fetal growth. However, most studies have conducted single-cohort analyses, which are often limited by narrow exposure ranges, and evaluated metals individually. The objective of the current study was to conduct an environmental mixture analysis of metal impacts on fetal growth, pooling data from three geographically and demographically diverse cohorts in the United States participating in the Environmental Influences on Child Health Outcomes program.

METHODS

The pooled sample (N = 1,002) included participants from the MADRES, NHBCS, and PROTECT cohorts. Associations between seven metals (antimony, cadmium, cobalt, mercury, molybdenum, nickel, tin) measured in maternal urine samples collected during pregnancy (median: 16.0 weeks gestation) and birth weight for gestational age z-scores (BW for GA) were investigated using Bayesian Kernel Machine Regression (BKMR). Models were also stratified by cohort and infant sex to investigate possible heterogeneity. Chromium and uranium concentrations fell below the limits of detection for most participants and were evaluated separately as binary variables using pooled linear regression models.

RESULTS

In the pooled BKMR analysis, antimony, mercury, and tin were inversely and linearly associated with BW for GA, while a positive linear association was identified for nickel. The inverse association between antimony and BW for GA was observed in both males and females and for all three cohorts but was strongest for MADRES, a predominantly low-income Hispanic cohort in Los Angeles. A reverse j-shaped association was identified between cobalt and BW for GA, which was driven by female infants. Pooled associations were null for cadmium, chromium, molybdenum, and uranium, and BKMR did not identify potential interactions between metal pairs.

CONCLUSIONS

Findings suggest that antimony, an understudied metalloid, may adversely impact fetal growth. Cohort- and/or sex-dependent associations were identified for many of the metals, which merit additional investigation.

Human exposure to toxic elements through facial cosmetic products: Dermal risk assessment

Facial cosmetics are the most commonly consumed product, mainly by the women from all over the world irrespective of their age. The facial cosmetics may be contaminated with several toxic elements, which can get absorb on to the facial skin and migrate to the blood vessels. Hence the absorbed toxic elements can cause further adverse effects on the human body. The present study aims to assess the toxic element contents (arsenic, lead, nickel, mercury, and cadmium) in commonly consumed facial cosmetics (face powder, foundation, lightening creams, moisturizer, eye shadow, lipsticks, eyeliner, blush, mascara, sunscreen) and to carry out the risk assessment through different methods. The dermal risk was evaluated as SED, NOAEL, MoS, HQ and ILCR, which is linked with the exposure of selected toxic elements. The total CDDE for all selected elements in facial cosmetic products was found in increasing order as follow: face powder > foundation > lightening creams > moisturizer > eye shadow > lipsticks > eyeliner > blush > mascara > sunscreen. The HQ and HI values for selected elements were found to be < 1 in all facial cosmetics. Whereas the probable MoS of selected toxic elements in all facial cosmetics except eyeliner were found to be 3-4 folds lower than the minimum value of 100 regulated by the WHO.

Heavy Metals and Human Health: Possible Exposure Pathways and the Competition for Protein Binding Sites

Heavy metals enter the human body through the gastrointestinal tract, skin, or via inhalation. Toxic metals have proven to be a major threat to human health, mostly because of their ability to cause membrane and DNA damage, and to perturb protein function and enzyme activity. These metals disturb native proteins’ functions by binding to free thiols or other functional groups, catalyzing the oxidation of amino acid side chains, perturbing protein folding, and/or displacing essential metal ions in enzymes. The review shows the physiological and biochemical effects of selected toxic metals interactions with proteins and enzymes. As environmental contamination by heavy metals is one of the most significant global problems, some detoxification strategies are also mentioned.

Natural and Conventional Cosmetics-Mercury Exposure Assessment

Mercury (Hg) can enter the human body through the respiratory tract and digestive system, but also through the skin. Sources of Hg in the environment can be natural processes, but also human activities, including agriculture, chemical, and pharmaceutical industries. Hg can also enter the body through food, but also with cosmetics that are used for a long time. Therefore, the aim of this study was to evaluate the Hg content in 268 randomly selected cosmetics: Natural and conventional, for face and body. Hg content was determined using an atomic absorption spectrometer (AMA 254, Leco, Prague, Czech Republic). It was shown that the face preparations were characterized by a significantly higher Hg content than the body preparations. No differences in the content of the tested element were found between natural and conventional preparations. Hg could be detected in all samples with concentrations measured from 0.348 to 37.768 µg/kg.

Mercury poisoning of a 4-year-old child by indirect contact to a mercury-containing facial cream: A case report

We report the severe mercury poisoning of a 4-year-old child by a so far unknown route of exposure, namely, by skin-to-skin contact. The child was admitted to the hospital with episodic pain in his extremities, tachycardia, hypertension, increased sweating, behavioral changes and weight loss. Extensive examinations eventually revealed an acute mercury poisoning. The initial mercury levels were 19 µg/L in urine (reference level 0.4 µg/L) and 37 µg/L in blood (reference level 0.8 µg/L). A facial cream bought online, containing approximately 18% mercury, was identified as the primary source of intoxication. The symptoms improved after disposal of the cream and chelation therapy. Further analyses, home visits and interviews suggested that the child was accidently intoxicated by skin-to-skin contact with the mother, although other routes of exposure such as dust ingestion and surface-to-skin contact cannot be excluded. The mercury levels in urine and blood samples of the child and other family members as well as in domestic dust samples decreased considerably over time.

Clinical management of chronic mercury intoxication secondary to skin lightening products: A proposed algorithm

Mercury is a toxic substance that is commonly used in skin lightening products. Various effects on humans have been observed, which affect both users and non-users. Many studies reported delayed diagnosis and treatment, even after weeks of hospitalization. The possible reasons are non-specific clinical manifestation and lack of awareness and knowledge regarding chronic mercury intoxication secondary to skin lightening products. A thorough history of mercury exposure is crucial. Physical assessment and relevant supporting tests are indicated to establish a diagnosis. Blood and urine mercury levels are an essential examination for diagnosis and monitoring of the progress and response to treatment. The primary treatment is the discontinuation of the skin lightening products. Chelation therapy is not mandatory and is usually indicated for symptomatic patients. The prognosis depends on the duration of the product use, concentration of mercury in the skin product, and the severity of clinical presentation.

Acute intranasal intoxication with mercuric chloride taken accidently instead of cocaine - A case report

CONTEXT

Mercuric chloride (mercury (II) chloride) belongs to inorganic mercury compounds characterized by good water solubility and associated high toxicity. The paper describes an unusual case of intranasal intoxication with corrosive sublimate confused with cocaine by a young male.

CASE REPORT

Intranasal administration of corrosive sublimate caused severe local symptoms of chemical burn within the nasal cavity. From the 2nd day the patient developed symptoms of renal dysfunction with transient polyuria and serum retention of nitrogen metabolites. The patient was undergoing chelation therapy with DMPS, N-acetylcysteine and d-penicyllamine. Four procedures of haemodialysis were performed with simultaneous DMPS and N-acetylcysteine treatment. The urine mercury level on the first day of hospitalization was 1989 μg/L, and after 26 days of treatment returned to the physiological level. During treatment renal function was normalized, the patient was discharged in general good condition.

DISCUSSION

Mercuric chloride is readily absorbed from the nasal cavity. Its administration may cause intoxication manifested by both chemical burn at the exposure site and systemic symptoms, particularly renal impairment. Even in case of renal dysfunction the use of DMPS seems safe, if haemodialysis is performed at the same time. Simultaneous haemodialysis and chelation therapy may accelerate elimination of mercury from the organism.

Mercury in skin-care products in India and consumer exposure risks

We report concentrations of mercury in skin-care products in India and the associated health risks. Mercury concentrations were 0.11 μg/kg (median; 5th percentile-95th percentile = 0.04-0.58 μg/kg; n = 24) in body lotions, 0.22 μg/kg (0.04-0.38 μg/kg, n = 10) in moisturizing lotions, 0.67 μg/kg (0.30-1.33 μg/kg, n = 8) in blemish balms, 0.16 μg/kg (0.06-7.43 μg/kg, n = 11) in bleaches, 0.13 μg/kg (0.04-0.98 μg/kg, n = 34) in skin lightning (fairness) creams manufactured within the country, and 9.24 × 10⁶ μg/kg (2.92 × 10⁶-3.17 × 10⁷ μg/kg, n = 14) in imported skin lightning (fairness) creams, much higher than the 1 ppm (1 ppm = 10³ μg/kg) regulatory limit. Probabilistic human health risk assessment for adult women (age > 21 y) revealed that computed hazard quotients from dermal exposure to the high-mercury fairness creams were >100 in all cases. The mass of mercury entering into the society via skin-care products is highly sensitive to the mass of high-mercury fairness creams that is imported to India; ten tonnes of import can introduce 29-317 kg of mercury every year. As such, analysis and labeling of mercury contents in skin-care products by manufacturers, and raising awareness among regulatory authorities to restrict the import of high-mercury fairness creams, is required.

Prenatal Metal Mixtures and Birth Weight for Gestational Age in a Predominately Lower-Income Hispanic Pregnancy Cohort in Los Angeles

BACKGROUND

Reduced fetal growth increases the risk for adverse health outcomes. Growing evidence suggests that metal exposures contribute to reduced fetal growth, but little is known about the effects of complex metal mixtures.

OBJECTIVES

We investigated the impact of a complex mixture of metals on birth weight for gestational age (BW for GA) in the Maternal and Developmental Risks from Environmental and Social Stressors study, a predominately lower-income Hispanic pregnancy cohort in Los Angeles, California.

METHODS

Cadmium (Cd), cobalt (Co), mercury (Hg), nickel (Ni), molybdenum (Mo), lead (Pb), antimony (Sb), tin (Sn), and thallium (Tl) were measured by inductively coupled plasma mass spectrometry (ICP-MS) in maternal urine samples collected in early pregnancy (median GA: 13.1 wk). Speciated urinary arsenic (As) (inorganic+monomethyl+dimethyl As) was measured by high-performance liquid chromatography coupled to ICP-MS. Primary analyses focused on a mixture of seven metals that have previously been associated individually with fetal growth (i.e., As, Cd, Co, Hg, Ni, Pb, Tl) (n=262). In exploratory analyses, we additionally examined three metals that have been less studied in relation to fetal growth (i.e., Mo, Sb, Sn). Covariate-adjusted Bayesian kernel machine regression was used to investigate metal mixture associations with BW for GA z-scores.

RESULTS

In primary analyses, Hg and Ni ranked highest as predictors of BW for GA. An inverse linear association was estimated for Hg, whereas a positive association was estimated for Ni at low-to-moderate concentrations. A potential interaction between Hg and Ni was also identified. In our exploratory analysis, Sb ranked highest as a predictor of BW for GA, followed by Hg and Ni.

CONCLUSIONS

Our findings suggest that in this understudied population, Hg may reduce fetal growth, whereas Ni may promote fetal growth. We also identified Sb as a potential metal of concern for this population, which merits additional investigation. https://doi.org/10.1289/EHP7201.

Mercury Exposure and Health Problems of the Students Using Skin-Lightening Cosmetic Products in Makassar, South Sulawesi, Indonesia

Despite legal and safety issues, skin-lightening cosmetic products—including hazardous mercury-containing cosmetics—are in increasing demand in Indonesia. Perceptions of beauty may result in desires to have lighter skin tones, regardless of the safety of these cosmetics, which block the production of melanin and thus lighten skin tone. This study investigated Hg exposure of students using skin-lightening cosmetics and assessed the health issues. A total of 105 female students were given a questionnaire regarding their use of cosmetics; a further 43 students formed a non-cosmetic-user control group. Their scalp hair and cosmetic products were analyzed by particle-induced X-ray emission (PIXE) spectroscopy. The geometric-mean hair Hg concentration for the cosmetics-using students was 6.7 µg g−1—three times that of the control group (2.3 µg g−1). Of twenty-seven cosmetic samples were analyzed, twenty had Hg concentrations of 0.12–7834.4 µg g−1 (mean 554.6 µg g−1), and seven had no detectable Hg. The hair Hg concentrations exhibited a statistically significant correlation with cosmetic Hg concentration. The health assessments indicated only rigidity & ataxia and irregular eye movement were prevalent in the cosmetic-using students with less than 7% occurrences.

Spinal cord neurodegeneration after inorganic mercury long-term exposure in adult rats: Ultrastructural, proteomic and biochemical damages associated with reduced neuronal density

Mercury chloride (HgCl₂) is a chemical pollutant widely found in the environment. This form of mercury is able to promote several damages to the Central Nervous System (CNS), however the effects of HgCl₂ on the spinal cord, an important pathway for the communication between the CNS and the periphery, are still poorly understood. The aim of this work was to investigate the effects of HgCl₂ exposure on spinal cord of adult rats. For this, animals were exposed to a dose of 0.375 mg/kg/day, for 45 days. Then, they were euthanized, the spinal cord collected and we investigated the mercury concentrations in medullary parenchyma and the effects on oxidative biochemistry, proteomic profile and tissue structures. Our results showed that exposure to this metal promoted increased levels of Hg in the spinal cord, impaired oxidative biochemistry by triggering oxidative stress, mudulated antioxidant system proteins, energy metabolism and myelin structure; as well as caused disruption in the myelin sheath and reduction in neuronal density. Despite the low dose, we conclude that prolonged exposure to HgCl₂ triggers biochemical changes and modulates the expression of several proteins, resulting in damage to the myelin sheath and reduced neuronal density in the spinal cord.

Chemical analysis of Hg0-containing Hindu religious objects

Parad items used in Hindu practices and Ayurvedic medicines contain elemental mercury (Hg⁰) and have traditionally been used in prayer and to treat a variety of diseases including diabetes, heart conditions, and sexual dysfunction. These items are often referred to as amalgams of silver, and take the form of shivlings, statues of gods, necklaces, and other jewelry. Fourteen parad items were purchased from online vendors in India and the United States and analyzed. All items produced copious amounts of Hg⁰ vapor, with Hg⁰ concentrations exceeding 1,000,000 ng/m³ as measured using a Mercury Instruments Mercury Tracker 3000 IP atomic absorption spectrometer. Measured concentrations were highly variable, so a simple qualitative experiment employing a UV-C light source and a thin-layer chromatography plate impregnated with a fluorescent dye that glows green when irradiated at 254 nm allowed for the indirect visualization of the Hg⁰ being evolved. In addition, all items were screened using a hand-held X-ray fluorescence analyzer to estimate the concentration of Hg, Sn, Pb, As, and Cd on the surface of the item. Select samples were then digested in aqua regia and analyzed for Hg content using a direct mercury analyzer. All samples were found to exceed 20% by mass Hg. The digestates were analyzed using inductively-coupled plasma–optical emission spectrometry and were determined to be between 10–55% by mass Pb and contain up to 0.3% by mass As. While Article 4 of the Minamata Convention on Mercury specifically requires parties to stop importing, exporting, and manufacturing Hg-added products, products used in traditional and religious practices are excluded.

A test strip platform based on a whole-cell microbial biosensor for simultaneous on-site detection of total inorganic mercury pollutants in cosmetics without the need for predigestion

Mercury pollutants such as mercuric chloride (HgCl₂), mercurous chloride (Hg₂Cl₂) and mercuric ammonium chloride (Hg(NH₂)Cl) are often found in cosmetics. Previous attempts at the on-site detection of mercury were hindered by the complicated and dangerous pretreatment procedure of converting various forms of mercury to Hg (II) ions. In this study, a test strip platform was developed based on a whole-cell microbial biosensor for the simultaneous detection of soluble and insoluble inorganic mercury pollutants in cosmetics without the need for predigestion. The genetic circuits with constitutively expressed MerR as sensor proteins and inducible red fluorescent protein (RFP) as the reporter were introduced into Escherichia coli to construct the mercury detection biosensor. The RFP fluorescence intensity of this biosensor showed a excellent linear relationship (R² = 0.9848) with the Hg (II) concentration ranging from 50 nM to 10 μM in Luria-Bertani (LB) broth. Further research indicated that this biosensor could respond not only to Hg (II) ions but also to insoluble Hg₂Cl₂ and Hg₂Cl₂. The transcriptomic results confirmed the mercury conversion ability of the whole-cell biosensor from a gene expression perspective. This biosensor was embedded on filter paper to form a test strip, which could be used to determine whether the total inorganic mercury pollutants in cosmetics exceeded 1 mg/kg. Therefore, this strip provided a low cost, easy-to-use, and instrument-independent method for the detection of mercury pollution in cosmetics, while this study revealed the unique advantages of microbial biosensors in the automatic bioconversion of targets.

Protective effect of high zinc levels on preterm birth induced by mercury exposure during pregnancy: A birth cohort study in China

OBJECTIVE

The aims of our study were to determine whether prenatal mercury levels are associated with the risk of preterm birth (PTB) and whether high maternal serum zinc (Zn) levels alleviate any negative effects of maternal mercury (Hg) exposure regarding PTB.

METHODS

Serum concentrations of Zn and Hg were measured in 3025 pregnant women from the Ma'anshan Birth Cohort. Before the collection of blood samples, they underwent examinations via the completion of questionnaires. The delivery records of the women were obtained from a series of medical records. We divided the study population into tertiles according to the participants' Hg levels: the low-Hg group (the first tertile, <0.30 μg/L), the medium-Hg group (the second tertile, 0.30-0.43 μg/L) and the high-Hg group (the third tertile, ≥0.43 μg/L). The associations of Hg exposure with both the risk of PTB and gestational age (weeks) at birth were estimated using a binary logistic regression model and multivariable linear regression analysis, respectively. Afterwards, we conducted a repeated analyses test after the participants were stratified according to their Zn levels, using the 75th percentile division method.

RESULTS

Overall, the medians and the interquartile ranges of Hg and Zn in the second trimester were 0.36 (0.27, 0.48) μg/L and 812.34 (731.26, 896.59) μg/L, respectively. Hg levels were associated with PTB [adjusted odds ratio (OR) and 95% confidence interval (95% CI): 1.91 (1.17, 3.12) for the third tertile vs. the first tertile of the serum Hg levels]. In the stratification analysis of the participants in the low-Zn group, the high-Hg group exhibited a significant odds ratio of PTB [adjusted OR (95% CI): 1.87 (1.08, 3.24)], compared to the low-Hg group. However, in the participants from the high-Zn group, the high-Hg group exhibited a non-significant OR of PTB [adjusted OR (95% CI): 2.32 (0.73, 7.42)]. In the multivariate linear regression analysis, gestational age (weeks) at delivery was significantly and inversely associated with the ln-transformed Hg concentrations [adjusted β (95% CI): -0.16 (-0.26, -0.06)]. Similarly, after the stratification analysis in the high-Zn group, there were no significant associations between PTB and the Hg levels [adjusted β (95% CI): -0.12 (-0.33, 0.09)].

CONCLUSION

Prenatal Hg exposure adversely affected PTB, and high Zn levels alleviate this effect, which indicates that a more stringent control of Hg and a sufficient intake of Zn are necessary to help birth outcomes.

Updated Global and Oceanic Mercury Budgets for the United Nations Global Mercury Assessment 2018

In support of international efforts to reduce mercury (Hg) exposure in humans and wildlife, this paper reviews the literature concerning global Hg emissions, cycling and fate, and presents revised global and oceanic Hg budgets for the 2018 United Nations Global Mercury Assessment. We assessed two competing scenarios about the impacts of 16th - late 19th century New World silver (Ag) mining, which may be the largest human source of atmospheric Hg in history. Consideration of Ag ore geochemistry, historical documents on Hg use, and comparison of the scenarios against atmospheric Hg patterns in environmental archives, strongly support a "low mining emission" scenario. Building upon this scenario and other published work, the revised global budget estimates human activities including recycled legacy emissions have increased current atmospheric Hg concentrations by about 450% above natural levels (prevailing before 1450 AD). Current anthropogenic emissions to air are 2.5 ± 0.5 kt/y. The increase in atmospheric Hg concentrations has driven a ∼ 300% average increase in deposition, and a 230% increase in surface marine waters. Deeper marine waters show increases of only 12-25%. The overall increase in Hg in surface organic soils (∼15%) is small due to the large mass of natural Hg already present from rock weathering, but this figure varies regionally. Specific research recommendations are made to reduce uncertainties, particularly through improved understanding of fundamental processes of the Hg cycle, and continued improvements in emissions inventories from large natural and anthropogenic sources.

Neurodevelopmental Effects of Mercury

The toxicology of mercury (Hg) is of concern since this metal is ubiquitously distributed in the environment, and living organisms are routinely exposed to Hg at low to high levels. The toxic effects of Hg are well studied and it is known that they may differ depending on the Hg chemical species. In this chapter, we emphasize the neurotoxic effects of Hg during brain development. The immature brain is more susceptible to Hg exposure, since all the Hg chemical forms, not only the organic ones, can harm it. The possible consequences of Hg exposure during the early stages of development, the additive effects with other co-occurring neurotoxicants, and the known mechanisms of action and targets will be addressed in this chapter.

Mercury Poisoning in a Toddler from Home Contamination due to Skin-Lightening Cream

A 17-month-old child presented with hypertension, fussiness, constipation, and arthralgia due to mercury toxicity from a skin-lightening cosmetic used by her mother and grandmother. Blood mercury level was 26 mcg/L and urine level was 243 mcg/g creatinine. She was chelated with succimer. The home was contaminated and needed remediation.

A review of guidance on fish consumption in pregnancy: is it fit for purpose?

OBJECTIVE

Public health messages to reduce Hg exposure for pregnant women have focused exclusively on advice on fish consumption to limit Hg exposure, with little account being taken of the positive contribution of fish to nutritional quality. The aim of the present review was to compare and contrast the content and presentation of national guidelines on fish consumption in pregnancy, and comment on their evidence base and impact on consumption.

DESIGN

We searched for national and international guidelines on fish consumption in pregnancy using Internet search strategies. The detailed content and style of presentation of the guidelines were compared. The evidence base for the guidelines, and evidence for the impact of the guidelines on fish consumption levels, were assessed.

RESULTS

We identified nineteen national guidelines and three international guidelines. There was great variation in the content, complexity and presentation style. The guidelines were based largely on the Hg content of fish with far less consideration being given to the positive beneficial effects of nutrients provided by fish. The complexity of the guidelines may lead to pregnant women reducing their fish intake, or not eating fish at all.

CONCLUSIONS

Guidelines on fish consumption in pregnancy should take the beneficial effects of fish into account. Guidelines need to be clear and memorable, and appropriately disseminated, to achieve impact. Guidelines could include visual rather than narrative content. Use of technology, for example apps, could enable women to record their fish consumption in real time and log compliance with guidance over a week or other time period.

Modulators of mercury risk to wildlife and humans in the context of rapid global change

Environmental mercury (Hg) contamination is an urgent global health threat. The complexity of Hg in the environment can hinder accurate determination of ecological and human health risks, particularly within the context of the rapid global changes that are altering many ecological processes, socioeconomic patterns, and other factors like infectious disease incidence, which can affect Hg exposures and health outcomes. However, the success of global Hg-reduction efforts depends on accurate assessments of their effectiveness in reducing health risks. In this paper, we examine the role that key extrinsic and intrinsic drivers play on several aspects of Hg risk to humans and organisms in the environment. We do so within three key domains of ecological and human health risk. First, we examine how extrinsic global change drivers influence pathways of Hg bioaccumulation and biomagnification through food webs. Next, we describe how extrinsic socioeconomic drivers at a global scale, and intrinsic individual-level drivers, influence human Hg exposure. Finally, we address how the adverse health effects of Hg in humans and wildlife are modulated by a range of extrinsic and intrinsic drivers within the context of rapid global change. Incorporating components of these three domains into research and monitoring will facilitate a more holistic understanding of how ecological and societal drivers interact to influence Hg health risks.

The toxicology of mercury: Current research and emerging trends

Mercury (Hg) is a persistent bio-accumulative toxic metal with unique physicochemical properties of public health concern since their natural and anthropogenic diffusions still induce high risk to human and environmental health. The goal of this review was to analyze scientific literature evaluating the role of global concerns over Hg exposure due to human exposure to ingestion of contaminated seafood (methyl-Hg) as well as elemental Hg levels of dental amalgam fillings (metallic Hg), vaccines (ethyl-Hg) and contaminated water and air (Hg chloride). Mercury has been recognized as a neurotoxicant as well as immunotoxic and designated by the World Health Organization as one of the ten most dangerous chemicals to public health. It has been shown that the half-life of inorganic Hg in human brains is several years to several decades. Mercury occurs in the environment under different chemical forms as elemental Hg (metallic), inorganic and organic Hg. Despite the raising understanding of the Hg toxicokinetics, there is still fully justified to further explore the emerging theories about its bioavailability and adverse effects in humans. In this review, we describe current research and emerging trends in Hg toxicity with the purpose of providing up-to-date information for a better understanding of the kinetics of this metal, presenting comprehensive knowledge on published data analyzing its metabolism, interaction with other metals, distribution, internal doses and targets, and reservoir organs.

The evaluation of total mercury and arsenic in skin bleaching creams commonly used in Trinidad and Tobago and their potential risk to the people of the Caribbean

Background. Skin lightening is very popular among women and some men of the Caribbean, and its popularity appears to be growing. The lightening of skin colour is done to produce a lighter complexion which is believed to increase attractiveness, social standing and improves one’s potential of being successful.

Design and Methods. Fifteen (15) common skin lightening creams found in pharmacies and cosmetic retailers throughout Trinidad and Tobago were evaluated for Mercury by Cold Vapor Atomic Absorption Spectrophotometry (CVAAS) and Arsenic by Hydride Generation Atomic Absorption Spectrophotometry (HGAAS). The results obtained were compared to global standards and previous research.

Results. Fourteen (14) of the fifteen samples analysed contained Mercury in the range of 0.473 μg/g to 0.766 μg/g. One sample had a Mercury content of 14,507.74±490.75 μg/g which was over 14,000 times higher than the USFDA limit for mercury in cosmetics of 1 μg/g. All samples contained Arsenic in the range 1.016 μg/g to 6.612 μg/g, which exceeds the EU limit for cosmetics of 0 μg/g.

Conclusions. All the samples analysed contained significant amounts of Mercury and Arsenic and none of them can be considered safe for prolonged human use. The samples that contained Mercury levels which were lower than the USFDA limit contained Arsenic levels which exceeded the EU standard of 0 μg/g in cosmetics. The popularity of these skin lightening creams in the Caribbean region places the population at elevated risk of chronic Mercury and Arsenic poisoning and possibly acute Mercury Poisoning.

Poisoning Through Pediatric Skin: Cases from the Literature

Poisoning through pediatric skin leading to acute systemic symptoms is a relatively uncommonly reported phenomenon. Systemic toxicity through the skin typically occurs by direct contact between therapeutic or non-therapeutic topical agents and the skin. Though uncommon, poisoning through pediatric skin can have significant consequences and must be recognized so the offending agent may be discontinued and appropriate treatment initiated. We performed a literature search for all article types between 1950 and April 2016 to provide a single source of detectable cases of acute toxicity in pediatric patients due to percutaneous exposure. This literature review discusses relevant pediatric skin physiology along with reports of poisoning events that resulted in systemic signs and symptoms and even death to provide a comprehensive report on causes of pediatric poisoning through the skin.

Mercury, hydroquinone and clobetasol propionate in skin lightening products in West Africa and Canada

Skin lightening products are types of cosmetics (creams, gels, lotions and soaps) applied voluntarily on skin. Several of these products contain a variety of active ingredients that are highly toxic. Among those toxic agents, the present study focuses on mercury, hydroquinone, and clobetasol propionate. Out of the 93 lightening soaps and 98 creams purchased in large city markets in sub-Saharan West Africa and in small ethnic shops in Canada, 68-84% of all creams and 7.5-65% of all soaps exceeded regulatory guidelines for at least one active ingredient when considering different regulations. Mercury was found in high concentrations mainly in soaps, while hydroquinone and clobetasol propionate concentrations exceeded US FDA standards in some creams for all countries included in our study. Concentrations of the three compounds declared on labels of soaps and creams usually did not correspond to concentrations actually measured, particularly for mercury and hydroquinone. Overall, our results indicate that most studied skin-lightening products are potentially toxic and that product labels are frequently inaccurate with respect to the presence of toxic agents.

Blood mercury levels and fish consumption in pregnancy: Risks and benefits for birth outcomes in a prospective observational birth cohort

Background

To avoid exposure to mercury, government advice on fish consumption during pregnancy includes information on fish species to avoid and to limit, while encouraging consumption of least two portions of fish per week. Some women may, however, chose to avoid fish completely during pregnancy despite potential benefits to the fetus.

Objectives

Our aims were to evaluate the effects of blood mercury levels in pregnant women on birth outcomes in the UK, and to compare outcomes in those who ate fish with those who did not.

Methods

Pregnant women were enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). Whole blood samples for singleton pregnancies with a live birth were analysed for Hg by inductively coupled plasma dynamic reaction cell mass spectrometry (n = 4044). Fish intake was determined by a food frequency questionnaire during pregnancy. Data collected on the infants included anthropometric variables and gestational age at delivery. Regression models were adjusted for covariates using SPSS v23.

Results

There were no significant associations of maternal blood Hg level with birthweight, head circumference or crown–heel length in adjusted linear regression models. Similarly, there were no increased odds of low birthweight or preterm delivery in adjusted logistic regression models. When the models were repeated after stratification into fish-eaters and there were no associations except for a negative association with birthweight in non-fish-eaters (unstandardised B coefficient −58.4 (95% confidence interval −113.8, −3.0) g, p = 0.039).

Conclusion

Moderate mercury levels in pregnancy were not associated with anthropometric variables, or on the odds of low birthweight or preterm birth. Fish consumption may have a protective effect on birthweight. Consumption of fish in line with government guidelines during pregnancy should be encouraged.