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

Introduction

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 cases reported delayed diagnosis and treatment, even after weeks of hospitalization. The possible reasons are non-specific clinical signs and symptoms, and the lack of awareness and knowledge regarding chronic mercury intoxication secondary to skin-lightening products.

The article published in BJBMS summarizes the evidences from various studies to guide clinician in the management of chronic mercury intoxication due to skin-lightening products.

Diagnosis and treatment of mercury poisoning

A thorough history of mercury exposure is crucial. This should include the duration and frequency of skin-lightening product use. Symptoms and signs of long term mercury exposure may range from no symptoms to severely debilitating conditions. The signs and symptoms are usually non-specific, such as headache, irritability, depression, memory loss, sleep disturbance, and leg swelling. Chronic mercury poisoning may also resemble other diseases, such as depression, dementia, and kidney disease.

Physical assessment and relevant supporting tests are indicated to establish a diagnosis. Blood and urine mercury levels are essential examinations for diagnosis and monitoring of the progress and response to treatment. Mercury levels in the suspected skin lightening product should be analyzed.

The main treatment is the discontinuation of the skin lightening products. Chelation therapy may be considered in certain conditions such as in symptomatic patients with high levels of mercury. Clinician must carefully evaluate the need of chelation. Chelation should not be used as a universal treatment due to its associated harmful adverse effects, doubtful clinical benefit in certain conditions as well as unknown long term adverse effects. Decontamination of contaminated household via safe disposal, the use of garden sulfur for decontamination, as well as a temporary vacancy may be indicated in certain conditions. The treatment outcome depends on the duration of the product use, concentration of mercury in the skin product and the severity of the clinical presentation.

What did the research show?

These research performed at Faculty of Medicine, Universiti Kebangsaan Malaysia show that a variety of non-specific symptoms and resemblance of other disorders or diseases may contribute to the difficulty in diagnosis and management of this condition. This article summarizes the essential components to guide in the management of chronic mercury poisoning from various case reports.

How this might influence/change clinical practice?

This article was written in hope to increase knowledge and awareness among clinician regarding the management of mercury poisoning due to skin-lightening products use. Skin-lightening use is common and various studies had reported its wide availability globally. Albeit, the cases reported are not common. A proposed algorithm in this article and published in BJBMS may be used as a guide in clinical practice.

More information:
Ramli FF. Clinical management of chronic mercury intoxication secondary to skin lightening products: A proposed algorithm. Bosn J of Basic Med Sci. 2020

Provided by Association of Basic Medical Sciences of FBIH