Chronic Mercury Intoxication in Children of Two Families Due to the Cosmetic Application of a Mercury Containing Bleaching Cream by the Mothers

We report about two families (A: n = 4, B: n = 5) from the KosovoAlbanian region where the mothers had been using a skin bleaching cream for cosmetic reasons from a rural market containing 12% elementary mercury. Elevated mercury levels in urine had first been detected in a survey of school pupils in one son of each family; this led to screening of all family members. Medical history showed no abnormalities in family A. In family B unspecific symptoms occurred such as headache, fatigue and bowel pain. In both families, no symptoms of Feer-syndrome (acrodynia) were observed. Nephrotic syndrome or anemia were excluded by blood analyses. Neurological examination, EEG and physical examination were normal. Using flameless atomic absorption spectroscometry, 24 h urine samples revealed elevated mercury levels with highest values in those female family members who had used the cream for cosmetic purposes (family A, A1: 226, A2: 86, A3: 25, A4: 14 mu g/l; family B, B1: 363; B2: 192; B3: 61; B4: 41; B5: 29 mu g/l). Reference values for adults are < 7 mu g/l in 24 h urine. After antidote treatment with DMPS (2,3 - dimercaptopropane-1-sulfonate, Sodium salt, Dimaval (R)) with 5 mg/kg bodyweight for 7 days, biomonitoring revealed a mercury level lower than the reference value and the symptoms ceased. In sensitive individuals, a symptom-complex (micromercuralism) with sporadic weakness, fatigue, gastrointestinal disorders, intention tremor (tremor mercuralis), alterations of the personality and memory loss (Erethrismus mercuralis) occur at a concentration of 100 mu g/l mercury in urine and 35 mu g/l in blood in adults. In the two families, absorption of the mercury in the boys might have occurred through the skin, by breathing or by ingestion.