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E-IJD® - CORRESPONDENCE |
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| Year : 2022 | Volume
: 67
| Issue : 6 | Page : 837 |
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| Beautification gone awry: Membranous glomerulonephritis following use of skin lightening cream containing mercury |
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PK Abraham Tharakan1, NV Seethalekshmy2
1 Department of Nephrology, SH Medical Centre, Kottayam, Kerala, India
2 Department of Pathology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| Date of Web Publication | 23-Feb-2023 |
Correspondence Address:
P K Abraham Tharakan
Department of Nephrology, SH Medical Centre, Kottayam, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_616_21
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How to cite this article:
Abraham Tharakan P K, Seethalekshmy N V. Beautification gone awry: Membranous glomerulonephritis following use of skin lightening cream containing mercury. Indian J Dermatol 2022;67:837 |
How to cite this URL:
Abraham Tharakan P K, Seethalekshmy N V. Beautification gone awry: Membranous glomerulonephritis following use of skin lightening cream containing mercury. Indian J Dermatol [serial online] 2022 [cited 2023 Mar 23];67:837. Available from: https://www.e-ijd.org/text.asp?2022/67/6/837/370328 |
Sir,
The use of skin fairness creams is quite popular in the Indian subcontinent. Unfortunately, some of these creams contain mercury due to its ability to suppress melanin production. Mercury has multiple toxic effects on the body including rashes, tremors, headache, weight loss, fatigue and kidney damage to mention a few. I would like to report an inadvertent renal side effect of using a mercury containing cream for skin lightening purposes and also create an awareness of the availability of such creams in the Indian market.
A 47-year-old lady presented to our out-patient department with complaints of bilateral pedal oedema of 5 months onset. Other than newly detected diabetes mellitus, and proteinuria of 1,500 mg/day, all other tests were normal. Since she was noted to have hyperpigmentation of both upper limbs with mildly elevated serum ANA levels, a kidney biopsy was done to rule out nondiabetic kidney disease. The biopsy showed features suggestive of membranous nephropathy [Figure 1]. Immunofluorescence study revealed fine granular capillary wall IgG and both kappa and lambda light chains. IgA, IgM, C3c and C1q were negative. Subsequently serum PLA2R was sent, which was negative. Other secondary workup including serum protein electrophoresis, viral markers including HIV/HBsAg/HCV, VDRL, chest x-ray, ultrasound abdomen and stool occult blood were all normal. An ANA profile done 2 weeks after the first report, was negative for all lupus autoantibodies including anti-dsDNA and Anti-Sm. She did not have any other features to suggest systemic lupus erythematosus. There was no history of NSAID use or use of native medications. On further probing her history she revealed that, due to her dark complexion, she had been using a skin lightening cream [Faiza Beauty Cream, [Figure 2]] on her face and forearms for the previous 2 years recommended by a local chemist. She had stopped using the cream following dermatologist advice after she noticed hyperpigmentation of her forearms. An internet search showed that this particular skin cream had already been banned in few countries due to its high mercury content. The cream was sent for heavy metal analysis and the mercury content was found to be 7,590 mg/kg (ICP-MS, Thermo-Fisher) which is 7,590 times higher than that prescribed by the Minamata convention. We did not test her blood/urine for mercury levels as she had stopped using the cream for >3 months. On subsequent follow-up, her proteinuria went into remission 9 months after stopping the cream and skin hyperpigmentation also reduced in severity. The reduction in proteinuria after stopping the skin cream does suggest that high mercury content in the skin cream could have been the cause of her membranous nephropathy. There have been multiple case reports of nephrotic syndrome[1],[2],[3] including membranous nephropathy following use of mercury containing skin lightening creams and mercury toxicity has also been related to autoimmunity and positive ANA levels.[4] | Figure 1: (a) Glomeruli with thick-walled open capillary loops (Jones silver Stain × 400), (b) Lucent holes (arrow) on capillary loops of glomerulus (Jones silver stain × 1000), (c) Immunofluorescence study: glomerulus with granular capillary wall IgG
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 | Figure 2: Creams available in the Indian market with high mercury content. Top right – Faiza cream used by our patient
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Skin lightening products are popular especially in many African, Asian and Caribbean countries.[5] Some of these creams contain mercury above the limit of 1 mg/kg or 1 ppm set by the Minamata Convention for skin lightening products. A report by the Zero Mercury Working Group[6] in 2018 found high levels of mercury ranging from 93 to 16,000 ppm in 10% of creams tested from 22 countries including many from the subcontinent [Table 1]. These creams are available in stores and also via online purchase in India as per another report.[7] [Figure 2] shows five such creams that were easily available and purchased personally from the online portal amazon.in. We should be aware of, and also probe this possibility when similar cases present to us. | Table 1: Skin care products with excessive mercury content available in the Indian subcontinent (With permission from Zero Mercury working group)[6]
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Li S-J, Zhang S-H, Chen H-P, Zeng C-H, Zheng C-X, Li L-S, et al. Mercury-induced membranous nephropathy: Clinical and pathological features. CJASN 2010;5:439-44.  |
| 2. | Chakera A, Lasserson D, Beck LH Jr, Roberts ISD, Winearls CG. Membranous nephropathy after use of UK-manufactured skin creams containing mercury. QJM 2011;104:893-6. |
| 3. | Chan TYK, Chan APL, Tang HL. Nephrotic syndrome caused by exposures to skin-lightening cosmetic products containing inorganic mercury. Clin Toxicol 2020;58:9-15. |
| 4. | Somers EC, Ganser MA, Warren JS, Basu N, Wang L, Zick SM, et al. Mercury exposure and antinuclear antibodies among females of reproductive age in the United States: NHANES. Environ Health Perspect 2015;123:792-8. |
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