MERCURY IN SKIN LIGHTENING PRODUCTS PREVENTING DISEASE THROUGH HEALTHY ENVIRONMENTS Mercury is a common but dangerous ingredient found in skin lightening creams and soaps. Beauty standards promoted by media, advertising and marketing reinforce the bias that lighter skin tone is more desirable than darker skin tone. Skin lightening creams and soaps are commonly used in many African, Asian and Caribbean nations (1, 2). They are also used among dark-skinned populations in Europe and North America (3–5). Mercury salts inhibit the formation of melanin, resulting in a lighter skin tone (6, 7). The Minamata Convention on Mercury establishes a limit of 1 mg/kg (1 ppm) for skin lightening products (8), yet many cosmetic products contain mercury levels higher than that amount to increase whitening effect (9, 10). Despite having been banned in many countries, mercury-containing products are often easily obtainable (11). Mercury can be eliminated from skin lightening products by working with health and environmental ministries and raising public awareness about the dangers to health from mercury and other hazardous chemicals in skin lightening products. To stop the manufacture, import and export of skin lightening products in line with the Minamata Convention, regulatory actions by governments are needed – including training of customs agents – as well as major media and advocacy campaigns. Use, production and availability • Skin lightening products are used worldwide, but their use is particularly widespread in many African, Asian and Caribbean countries (1, 12). Skin lightening products are used by both women and men (13). • The skin lightening industry is one of the fastest growing beauty industries worldwide and is estimated to be worth US$ 31.2 billion by 2024 (14). In India, for example, the skin lightening industry (including products with and without mercury) represents 50% of the skincare market and is estimated to be worth US$ 450–535 million (14). • Mercury-containing skin lightening products are manufactured in many countries and areas, including Bangladesh (15), China (16, 17), Dominican Republic (18), Hong Kong SAR (China) (15), Jamaica (15), Lebanon (19), Malaysia (15), Mexico (17, 20), Pakistan (21), Philippines (22), Republic of Korea (15), Thailand (23, 24), and the United States of America (25). • Mercury-containing skin lightening products are available for sale over the Internet, promoted online on social media sites, and sold through mobile apps. According to the United States Food and Drug Administration (FDA), these products are often manufactured abroad and sold illegally in the United States, often in small shops and informal markets catering to Latino, Asian, African or Middle Eastern communities. Consumers also purchase them in other countries and bring them back to their country (26). The toxic trade of often illegal mercury-added skin lightening products is a global crisis expected to only worsen with skyrocketing demand, especially in Africa, Asia and the Middle East (15). • A 2011 survey funded by the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety noted that individuals from Brazil, Kyrgyzstan, Mexico and the Russian Federation believe that mercury-containing skin lightening products are easy to obtain (11). • A study conducted by the Zero Mercury Group in 2017 and 2018 collected 338 samples of skin lightening creams from 22 countries in both formal and informal markets to identify a “snapshot” of the frequency and concentrations where mercury is used as an active ingredient in skin lightening creams worldwide. Thirty-four creams (10% of the samples) were found to have high mercury levels, i.e. above 1 ppm. These high mercury samples were found in seven of the 22 countries. Of these seven countries, four had requirements prohibiting more than 1 ppm mercury content. Overall, the mercury concentrations in these particular products ranged from 93 ppm to over 16 000 ppm (15). Other studies have found even higher concentrations of mercury in skin lightening products (27). • Since 2010, the California Department of Public Health’s Environmental Health Investigations Branch (EHIB) has conducted investigations of poisonings involving mercury in blemish and spot-removing face cream products. They have found a variety of mercury-containing products from Cambodia, China, Japan, Mexico, Pakistan and the Philippines. The EHIB determined that some of the products caused serious health problems, including health problems that required hospitalization (28). • Many countries have enacted legislation banning mercury-containing cosmetics, but many others have not. Despite legislation prohibiting mercury- containing products, their availability remains a problem (29). Even where distribution is banned, mercury-containing products are often still easily obtainable (11). • Skin lightening products that do not contain mercury may contain other hazardous substances, such as hydroquinone. In places where skin lightening products are used, consumers may be unaware of the harmful effects of the chemicals in these products (30). Products, packaging and ingredients • Skin lightening products come in different forms, including creams and soaps. The soap may be sold as “antiseptic soap” (3). These products are supposed to be applied to the skin to dry overnight (3). Both women and men use the soap to wash their hair, arms, face or entire body (3). It is reported that some individuals have used these products for decades (1). • The soaps, which are sold in stores and online, come in bar form and are sold individually in boxes (4). The creams are generally packaged in tubes or jars (4). The soaps contain approximately 1–3% mercury iodide and the creams are composed of 1–10% mercury ammonium (3). Some soap products that have been tested contained mercury at concentrations up to 31 mg/kg (31 ppm), whereas some cream products have been found to have mercury concentrations as high as 33 000 mg/kg (33 000 ppm) (27). The Minamata Convention establishes a limit of 1 mg/kg (1 ppm) for skin lightening products, yet many cosmetic products contain mercury levels higher than 1 mg/kg (1 ppm) to increase whitening effect (9, 10). • The amount or concentration of mercury in a product may be labelled on the packaging or listed in the ingredients list. Names to look for include: mercury, Hg, mercuric iodide, mercury oxide, mercurous chloride, ethyl mercury, phenyl mercuric salts, ammoniated mercury, amide chloride of mercury, mercury iodide, or “poison”. Directions to avoid contact with silver, gold, rubber, aluminium and jewellery may also indicate the presence of mercury (3, 4, 26, 31–33). Of great concern is that companies selling products containing mercury do not always list it as an ingredient. Other cosmetics containing mercury • Mercury may also be found in cosmetics for the eye area, such as mascara, and in eye makeup cleansing products, where it is used as a preservative (1, 3, 31). • Mercury in cosmetics exists in two forms: inorganic and organic (31, 34, 35). Inorganic mercury is used in skin lightening creams and soaps. Organic mercury compounds (e.g. thiomersal, which contains ethyl mercury, and phenyl mercuric salts) are used as cosmetic preservatives in eye makeup, including mascara, and in eye makeup cleansing products (3, 31–33). These forms of mercury differ in their degree of toxicity, and have varying effects on the nervous, digestive and immune systems, as well as the lungs, kidneys, skin and eyes (36). • The Minamata Convention does not establish a limit for eye area cosmetics where mercury is used as a preservative, and no effective and safe substitutes are available (8). 2 Health effects • Adverse health effects of the inorganic mercury contained in skin lightening creams and soaps include: kidney damage (7), skin rashes, skin discolouration and scarring, reduction in the skin’s resistance to bacterial and fungal infections (31), anxiety, depression, psychosis and peripheral neuropathy (3, 31). • The medical literature reports specific instances of individuals suffering from the aforementioned health effects following exposure to mercury through skin lightening creams and soaps. One case report describes a 34-year-old Chinese woman who developed nephrotic syndrome, a condition marked by high levels of protein in the urine. Nephrotic syndrome can be associated with a series of complications that affect an individual’s health and quality of life. The mercury levels in the woman’s blood and urine returned to normal one month and nine months, respectively, after she stopped using the skin lightening cream (37). Another case report describes a 54-year-old woman with an onset of dementia, epilepsy and peripheral polyneuropathy at the age of 49. After six years of daily skin lightening cream application, exposure was stopped immediately, after which her blood and urine mercury levels returned to unexposed levels (38). • One study revealed a large proportion of nephrotic syndrome among African women using ammoniated mercuric chloride–containing skin lightening creams for periods ranging from one month to three years. After cessation of mercury-containing skin lightening creams, urine mercury levels rapidly fell to within the unexposed range. Over three quarters of the women who stopped using the creams went into remission (7, 39). • Mercury in soaps, creams and other cosmetic products is eventually discharged into waste water. The mercury then enters the environment, where it becomes methylated and can enter the food chain as highly toxic methylmercury in fish (3). Pregnant women who consume fish containing methylmercury can transfer the mercury to their fetuses, which can result in neurodevelopmental deficits in the children (3). • Exposure to inorganic mercury can be quantified through measurements in blood and urine (34). Regulations • The Minamata Convention on Mercury is a global treaty “to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds” (8). It entered into force on 16 August 2017 and as of November 2019, 114 countries had ratified the Convention. After 2020, Parties to the Convention are required to have banned the manufacture, import and export of “Cosmetics (with mercury content above 1 ppm), including skin lightening soaps and creams, and not including eye area cosmetics where mercury is used as a preservative and no effective and safe substitute preservatives are available” except where the Party has registered an exemption to 2025 (8, 40). As of November 2019, a number of Parties had registered such an exemption (8, 41). The intention of the Convention is not to cover cosmetics, soaps or creams with trace contaminants of mercury (8). • The European Union (42, 43) and many other countries have regulations banning mercury-containing cosmetics. These include Canada (44), Philippines (24) and the United States (45), as well as a number of African nations (11), including Ghana, Nigeria and Uganda (12). Actions needed • To protect the public from negative health effects of mercury in skin lightening products, actions are needed that engage different parts of society, such as, but not limited to: establishing or improving legislation; implementing compliance and enforcement strategies for legislation, including training for customs agents and identification of manufacturers and supply chains; strengthening laboratory capacity to test for mercury in skin lightening products; conducting advocacy campaigns run by national health authorities, and public awareness campaigns to inform consumers about the health risks of skin lightening products, including those containing mercury; and increasing awareness among health professionals of health risks associated with skin lightening products, including those containing mercury, to inform and educate patients and the community. 3 Conclusions • Mercury-containing skin lightening products are hazardous to health and as a result have been banned in many countries. Even in some countries where such products have been banned, they are still advertised and available to consumers via the Internet and other means. • There is a great need for public awareness given the worldwide increase in the use of cosmetic products containing mercury. • Information on the hazards of skin lightening products in general must be provided to consumers as even skin lightening products that do not contain mercury may contain other hazardous substances, such as hydroquinone. For further WHO information on mercury, please visit: https://www.who.int/health-topics/chemical-safety References 1. Dadzie OE, Petit AJ (2009). Skin bleaching: highlighting the misuse of cutaneous depigmenting agents. Eur Acad Dermatol Venereol, 23(7):741–750. 2. WHO (2008). Guidance for identifying populations at risk from mercury exposure. Geneva, World Health Organization (http://www.who.int/foodsafety/ publications/chem/mercuryexposure.pdf). 3. Glahder CM, Appel PWU, Asmund G (1999). Mercury in soap in Tanzania. Copenhagen, Ministry of Environment and Energy, National Environmental Research Institute (NERI Technical Report No. 306; http://www2.dmu.dk/1_viden/2_publikationer/3_ fagrapporter/rapporter/fr306.pdf). 4. New York City Department of Health and Mental Hygiene (2019). Mercury in soaps and creams. New York, NYC Health (http://www1.nyc.gov/site/doh/ health/health-topics/mercury-in-soaps-and-creams. page). 5. McKelvey W, Jeffery N, Clark N, Kass D, Parsons PJ (2011). Population-based inorganic mercury biomonitoring and the identification of skin care products as a source of exposure in New York City. Environ Health Perspect, 119(2):203–209. 6. Engler DE (2005). Mercury “bleaching” creams. J Am Acad Dermatol, 52(6):1113–1114. 7. IPCS (2003). Elemental mercury and inorganic mercury compounds: human health aspects. Geneva, World Health Organization, International Programme on Chemical Safety (Concise International Chemical Assessment Document 50; http://www.who.int/ entity/ipcs/publications/cicad/en/cicad50.pdf). 8. UNEP (2019). Text and Annexes. Minamata Convention on Mercury. Nairobi, United Nations Environment Programme (http://www. mercuryconvention.org/Convention/Text/tabid/3426/ language/en-US/Default.aspx). 9. U.S. FDA (2019). FDA’s testing of cosmetics for arsenic, cadmium, chromium, cobalt, lead, mercury, and nickel content. Silver Spring, United States Food and Drug Administration (https://www.fda.gov/ cosmetics/potential-contaminants-cosmetics/ fdas-testing-cosmetics-arsenic-cadmium- chromium-cobalt-lead-mercury-and-nickel-content). 10. Sun GF, Hu WT, Yuan ZH, Zhang BA, Lu H (2017). Characteristics of mercury intoxication induced by skin-lightening products. Chin Med J (Engl), 130(24):3003–3004. 11. Uram E, Bischofer BP, Hagemann S (2010). Market analysis of some mercury-containing products and their mercury-free alternatives in selected regions. Gesellschaft für Anlagenund Reaktorsicherheit (GRS) mbH, March (GRS-253) (http://ipen.org/sites/ default/files/documents/market_analysis_mercury- containing_products_alternatives-en.pdf). 12. UNEP (2019). Minamata Convention Initial Assessments (MIAs). Nairobi: United Nations Environment Programme (http://www.mercuryconvention.org/Implementation/ MinamataInitialAssessments/tabid/6166/language/ en-US/Default.aspx). 4 13. Peltzer K, Pengpid S, James C (2016). The globalization of whitening: prevalence of skin lighteners (or bleachers) use and its social correlates among university students in 25 countries. Int J Dermatol, 55(2):165–172. 14. Shroff H, Diedrichs PC, Craddock N (2018). Skin color, culture capital, and beauty products: an investigation of the use of skin fairness products in Mumbai, India. Front Public Health, 5:1–9. 15. EEB ZMWG (2018). Mercury-added skin-lightening creams. Available, inexpensive, and toxic. Brussels, European Environmental Bureau. Zero Mercury Working Group (https://eeb.org/publications/59/industry- health/95798/report-mercury-added-skin-lightening- creams-available-inexpensive-and-toxic.pdf). 16. RAPEX (2009). The Rapid Alert System for Dangerous Non-Food Products, 2009 week 49, No. 8, Alert number 1625/09 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=1625/09). 17. U.S. FDA (2019). Import Alert No. 66-41: Detention without physical examination of unapproved new drugs promoted in the U.S. Silver Spring, United States Food and Drug Administration (http://www. accessdata.fda.gov/cms_ia/importalert_190.html). 18. U.S. FDA (2019). Import Alert 53-18: Detention without physical examination of skin whitening creams containing mercury. Silver Spring, United States Food and Drug Administration (http://www. accessdata.fda.gov/cms_ia/importalert_137.html). 19. RAPEX (2006). The Rapid Alert System for Dangerous Non-Food Products, 2006 week 24, No. 16, Alert number 0356/06 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0356/06). 20. Peregrino CP, Moreno MV, Miranda SV, Rubio AD, Leal LO (2011). Mercury levels in locally manufactured Mexican skin-lightening creams. Int J Environ Res Public Health, 8(6):2516–2523. 21. RAPEX (2011). The Rapid Alert System for Dangerous Non-Food Products, 2011 week 31, No. 33, Alert number 0461/11 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0461/11). 22. RAPEX (2007). The Rapid Alert System for Dangerous Non-Food Products, 2007 week 29, No. 22, Alert number 0732/07 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0732/07). 23. RAPEX (2009). The Rapid Alert System for Dangerous Non-Food Products, 2009 week 28, No. 3, Alert number 0954/09 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0954/09). 24. Republic of the Philippines Food and Drug Administration (2011). List of cosmetic products found to contain mercury exceeding the allowable limit of 1ppm. Manila, Department of Health (https://www.doh.gov.ph/Health-Alerts/List-of- Cosmetic-Products-Found-to-Contain-Mercury- Exceeding-the-Allowable-Limit-of-1ppm). 25. RAPEX (2006). The Rapid Alert System for Dangerous Non-Food Products, 2006 week 31, No. 13, Alert number 0491/06 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0491/06). 26. U.S. FDA (2016). Mercury poisoning linked to skin products. Silver Spring, United States Food and Drug Administration (https://www.fda.gov/consumers/ consumer-updates/mercury-poisoning-linked-skin- products). 27. MDH (2016). Skin-lightening products found to contain mercury. St. Paul, Minnesota Department of Health (https://www.health.state.mn.us/ communities/environment/skin/). 28. CDPH (n.d.). Face creams containing mercury. Sacramento, California Department of Public Health. Environmental Health Investigations Branch (https://www.cdph.ca.gov/Programs/CCDPHP/ DEODC/EHIB/CPE/CDPH%20Document%20Library/ Word%20Creams%20Doc_FINAL_ADA.pdf). 29. Bell L, DiGangi J, Weinberg J (2014). An NGO introduction to mercury pollution and the Minamata Convention on Mercury. Gothenburg, International POPs Elimination Network (https://ipen.org/sites/ default/files/documents/ipen-booklet-hg-update- v1_6-en-2-web.pdf). 30. Jose A, Ray JG (2018). Toxic content of certain commercially available fairness creams in Indian market. Cogent Med, 5(1):1433104. 31. Ladizinski B, Mistry N, Kundu RV (2011). Widespread use of toxic skin lightening compounds: medical and psychosocial aspects. Dermatol Clin, 29(1):111–123. 32. Al-Saleh I, Al-Doush I (1997). Mercury content in skin-lightening creams and potential hazards to the health of Saudi women. J Toxicol Environ Health, 51(2):123–130. 5 WHO/CED/PHE/EPE/19.13 © World Health Organization 2019 Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damage arising from its use. This is an update of the information sheet with the same title published in 2011, which was financially supported by the German Ministry of Environment, Nature Conservation and Nuclear Safety. Department of Public Health, Environmental and Social Determinants of Health World Health Organization 20 Avenue Appia, 1211 Geneva 27, Switzerland 33. UNEP (2019). Lists of mercury compounds and mercury-added products. UNEP/MC/COP.3/INF/18. In: Information Documents from the Third Meeting of the Conference of the Parties to the Minamata Convention on Mercury (COP3). Nairobi, United Nations Environment Programme (document available for download from: http://www. mercuryconvention.org/Meetings/COP3). 34. ATSDR (1999). Toxicological profile for mercury. Atlanta, Agency for Toxic Substances & Disease Registry (http://www.atsdr.cdc.gov/toxprofiles/TP. asp?id=115&tid=24). 35. WHO (2007). Exposure to mercury: a major public health concern. Geneva, World Health Organization (Preventing disease through healthy environments series; http://www.who.int/phe/news/Mercury-flyer.pdf). 36. WHO (2017). Mercury and health. Key facts. Geneva, World Health Organization (https://who.int/news- room/fact-sheets/detail/mercury-and-health). 37. Tang HL, Chu KH, Mak YF, Lee W, Cheuk A, Yim KF, et al. (2006). Minimal change disease following exposure to mercury-containing skin lightening cream. Hong Kong Med J, 12(4):316–318. 38. Zellner T, Zellner N, Felgenhauer N, Eyer F (2016). Dementia, epilepsy, and polyneuropathy in a mercury-exposed patient: investigation, identification of an obscure source of treatment. BMJ Case Rep, 2016:bcr2016216835. 39. Barr RD, Rees PH, Cordy PE, Kungu A, Woodger BA, Cameron HM (1972). Nephrotic syndrome in adult Africans in Nairobi. Br Med J, 2(5806):131–134. 40. BRI (2018). Phasing out mercury-added products: skin lightening products and other cosmetics. Portland, Biodiversity Research Institute (http://www.briloon.org/uploads/BRI_Documents/ Mercury_Center/UNEP%20Projects/2019/FOR%20 WEB%20Global%20Cosmetics%20Flyer%20 revised%202019.pdf). 41. UNEP (2019). Exemptions Under the Minamata Convention on Mercury. Nairobi, United Nations Environment Programme. (http://www.mercuryconvention.org/Countries/ Parties/Exemptions/tabid/5967/language/en-US/ Default.aspx). 42. IPCS (1991). Mercury-containing cream and soap. In: Inorganic mercury. Geneva, World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 118; (http://www.inchem.org/documents/ehc/ehc/ehc118. htm#SectionNumber:3.5). 43. European Commission (2019). Annex V. List of preservatives allowed in cosmetic products. In: Regulation (EC) No. 1223/2009 of the European Parliament and of the Council. Updated July 11, 2019. Brussels, The European Commission (http://ec.europa.eu/growth/tools-databases/cosing/ pdf/COSING_Annex%20V_v2.pdf). 44. Health Canada (2012). Guidance on heavy metal impurities in cosmetics. Ottawa, Health Canada (http://www.hc-sc.gc.ca/cps-spc/pubs/indust/ heavy_metals-metaux_lourds/index-eng.php). 45. U.S. FDA (2019). CFR – Code of Federal Regulations Title 21. Chapter I: Food and Drug Administration. Subchapter G: Cosmetics. Silver Spring, United States Department Food and Drug Administration (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/ cfCFR/CFRSearch. cfm?fr=700.13&SearchTerm=mercury).
MERCURY IN SKIN LIGHTENING PRODUCTS PREVENTING DISEASE THROUGH HEALTHY ENVIRONMENTS Mercury is a common but dangerous ingredient found in skin lightening creams and soaps. Beauty standards promoted by media, advertising and marketing reinforce the bias that lighter skin tone is more desirable than darker skin tone. Skin lightening creams and soaps are commonly used in many African, Asian and Caribbean nations (1, 2). They are also used among dark-skinned populations in Europe and North America (3–5). Mercury salts inhibit the formation of melanin, resulting in a lighter skin tone (6, 7). The Minamata Convention on Mercury establishes a limit of 1 mg/kg (1 ppm) for skin lightening products (8), yet many cosmetic products contain mercury levels higher than that amount to increase whitening effect (9, 10). Despite having been banned in many countries, mercury-containing products are often easily obtainable (11). Mercury can be eliminated from skin lightening products by working with health and environmental ministries and raising public awareness about the dangers to health from mercury and other hazardous chemicals in skin lightening products. To stop the manufacture, import and export of skin lightening products in line with the Minamata Convention, regulatory actions by governments are needed – including training of customs agents – as well as major media and advocacy campaigns. Use, production and availability • Skin lightening products are used worldwide, but their use is particularly widespread in many African, Asian and Caribbean countries (1, 12). Skin lightening products are used by both women and men (13). • The skin lightening industry is one of the fastest growing beauty industries worldwide and is estimated to be worth US$ 31.2 billion by 2024 (14). In India, for example, the skin lightening industry (including products with and without mercury) represents 50% of the skincare market and is estimated to be worth US$ 450–535 million (14). • Mercury-containing skin lightening products are manufactured in many countries and areas, including Bangladesh (15), China (16, 17), Dominican Republic (18), Hong Kong SAR (China) (15), Jamaica (15), Lebanon (19), Malaysia (15), Mexico (17, 20), Pakistan (21), Philippines (22), Republic of Korea (15), Thailand (23, 24), and the United States of America (25). • Mercury-containing skin lightening products are available for sale over the Internet, promoted online on social media sites, and sold through mobile apps. According to the United States Food and Drug Administration (FDA), these products are often manufactured abroad and sold illegally in the United States, often in small shops and informal markets catering to Latino, Asian, African or Middle Eastern communities. Consumers also purchase them in other countries and bring them back to their country (26). The toxic trade of often illegal mercury-added skin lightening products is a global crisis expected to only worsen with skyrocketing demand, especially in Africa, Asia and the Middle East (15). • A 2011 survey funded by the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety noted that individuals from Brazil, Kyrgyzstan, Mexico and the Russian Federation believe that mercury-containing skin lightening products are easy to obtain (11). • A study conducted by the Zero Mercury Group in 2017 and 2018 collected 338 samples of skin lightening creams from 22 countries in both formal and informal markets to identify a “snapshot” of the frequency and concentrations where mercury is used as an active ingredient in skin lightening creams worldwide. Thirty-four creams (10% of the samples) were found to have high mercury levels, i.e. above 1 ppm. These high mercury samples were found in seven of the 22 countries. Of these seven countries, four had requirements prohibiting more than 1 ppm mercury content. Overall, the mercury concentrations in these particular products ranged from 93 ppm to over 16 000 ppm (15). Other studies have found even higher concentrations of mercury in skin lightening products (27). • Since 2010, the California Department of Public Health’s Environmental Health Investigations Branch (EHIB) has conducted investigations of poisonings involving mercury in blemish and spot-removing face cream products. They have found a variety of mercury-containing products from Cambodia, China, Japan, Mexico, Pakistan and the Philippines. The EHIB determined that some of the products caused serious health problems, including health problems that required hospitalization (28). • Many countries have enacted legislation banning mercury-containing cosmetics, but many others have not. Despite legislation prohibiting mercury- containing products, their availability remains a problem (29). Even where distribution is banned, mercury-containing products are often still easily obtainable (11). • Skin lightening products that do not contain mercury may contain other hazardous substances, such as hydroquinone. In places where skin lightening products are used, consumers may be unaware of the harmful effects of the chemicals in these products (30). Products, packaging and ingredients • Skin lightening products come in different forms, including creams and soaps. The soap may be sold as “antiseptic soap” (3). These products are supposed to be applied to the skin to dry overnight (3). Both women and men use the soap to wash their hair, arms, face or entire body (3). It is reported that some individuals have used these products for decades (1). • The soaps, which are sold in stores and online, come in bar form and are sold individually in boxes (4). The creams are generally packaged in tubes or jars (4). The soaps contain approximately 1–3% mercury iodide and the creams are composed of 1–10% mercury ammonium (3). Some soap products that have been tested contained mercury at concentrations up to 31 mg/kg (31 ppm), whereas some cream products have been found to have mercury concentrations as high as 33 000 mg/kg (33 000 ppm) (27). The Minamata Convention establishes a limit of 1 mg/kg (1 ppm) for skin lightening products, yet many cosmetic products contain mercury levels higher than 1 mg/kg (1 ppm) to increase whitening effect (9, 10). • The amount or concentration of mercury in a product may be labelled on the packaging or listed in the ingredients list. Names to look for include: mercury, Hg, mercuric iodide, mercury oxide, mercurous chloride, ethyl mercury, phenyl mercuric salts, ammoniated mercury, amide chloride of mercury, mercury iodide, or “poison”. Directions to avoid contact with silver, gold, rubber, aluminium and jewellery may also indicate the presence of mercury (3, 4, 26, 31–33). Of great concern is that companies selling products containing mercury do not always list it as an ingredient. Other cosmetics containing mercury • Mercury may also be found in cosmetics for the eye area, such as mascara, and in eye makeup cleansing products, where it is used as a preservative (1, 3, 31). • Mercury in cosmetics exists in two forms: inorganic and organic (31, 34, 35). Inorganic mercury is used in skin lightening creams and soaps. Organic mercury compounds (e.g. thiomersal, which contains ethyl mercury, and phenyl mercuric salts) are used as cosmetic preservatives in eye makeup, including mascara, and in eye makeup cleansing products (3, 31–33). These forms of mercury differ in their degree of toxicity, and have varying effects on the nervous, digestive and immune systems, as well as the lungs, kidneys, skin and eyes (36). • The Minamata Convention does not establish a limit for eye area cosmetics where mercury is used as a preservative, and no effective and safe substitutes are available (8). 2 Health effects • Adverse health effects of the inorganic mercury contained in skin lightening creams and soaps include: kidney damage (7), skin rashes, skin discolouration and scarring, reduction in the skin’s resistance to bacterial and fungal infections (31), anxiety, depression, psychosis and peripheral neuropathy (3, 31). • The medical literature reports specific instances of individuals suffering from the aforementioned health effects following exposure to mercury through skin lightening creams and soaps. One case report describes a 34-year-old Chinese woman who developed nephrotic syndrome, a condition marked by high levels of protein in the urine. Nephrotic syndrome can be associated with a series of complications that affect an individual’s health and quality of life. The mercury levels in the woman’s blood and urine returned to normal one month and nine months, respectively, after she stopped using the skin lightening cream (37). Another case report describes a 54-year-old woman with an onset of dementia, epilepsy and peripheral polyneuropathy at the age of 49. After six years of daily skin lightening cream application, exposure was stopped immediately, after which her blood and urine mercury levels returned to unexposed levels (38). • One study revealed a large proportion of nephrotic syndrome among African women using ammoniated mercuric chloride–containing skin lightening creams for periods ranging from one month to three years. After cessation of mercury-containing skin lightening creams, urine mercury levels rapidly fell to within the unexposed range. Over three quarters of the women who stopped using the creams went into remission (7, 39). • Mercury in soaps, creams and other cosmetic products is eventually discharged into waste water. The mercury then enters the environment, where it becomes methylated and can enter the food chain as highly toxic methylmercury in fish (3). Pregnant women who consume fish containing methylmercury can transfer the mercury to their fetuses, which can result in neurodevelopmental deficits in the children (3). • Exposure to inorganic mercury can be quantified through measurements in blood and urine (34). Regulations • The Minamata Convention on Mercury is a global treaty “to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds” (8). It entered into force on 16 August 2017 and as of November 2019, 114 countries had ratified the Convention. After 2020, Parties to the Convention are required to have banned the manufacture, import and export of “Cosmetics (with mercury content above 1 ppm), including skin lightening soaps and creams, and not including eye area cosmetics where mercury is used as a preservative and no effective and safe substitute preservatives are available” except where the Party has registered an exemption to 2025 (8, 40). As of November 2019, a number of Parties had registered such an exemption (8, 41). The intention of the Convention is not to cover cosmetics, soaps or creams with trace contaminants of mercury (8). • The European Union (42, 43) and many other countries have regulations banning mercury-containing cosmetics. These include Canada (44), Philippines (24) and the United States (45), as well as a number of African nations (11), including Ghana, Nigeria and Uganda (12). Actions needed • To protect the public from negative health effects of mercury in skin lightening products, actions are needed that engage different parts of society, such as, but not limited to: establishing or improving legislation; implementing compliance and enforcement strategies for legislation, including training for customs agents and identification of manufacturers and supply chains; strengthening laboratory capacity to test for mercury in skin lightening products; conducting advocacy campaigns run by national health authorities, and public awareness campaigns to inform consumers about the health risks of skin lightening products, including those containing mercury; and increasing awareness among health professionals of health risks associated with skin lightening products, including those containing mercury, to inform and educate patients and the community. 3 Conclusions • Mercury-containing skin lightening products are hazardous to health and as a result have been banned in many countries. Even in some countries where such products have been banned, they are still advertised and available to consumers via the Internet and other means. • There is a great need for public awareness given the worldwide increase in the use of cosmetic products containing mercury. • Information on the hazards of skin lightening products in general must be provided to consumers as even skin lightening products that do not contain mercury may contain other hazardous substances, such as hydroquinone. For further WHO information on mercury, please visit: https://www.who.int/health-topics/chemical-safety References 1. Dadzie OE, Petit AJ (2009). Skin bleaching: highlighting the misuse of cutaneous depigmenting agents. Eur Acad Dermatol Venereol, 23(7):741–750. 2. WHO (2008). Guidance for identifying populations at risk from mercury exposure. Geneva, World Health Organization (http://www.who.int/foodsafety/ publications/chem/mercuryexposure.pdf). 3. Glahder CM, Appel PWU, Asmund G (1999). Mercury in soap in Tanzania. Copenhagen, Ministry of Environment and Energy, National Environmental Research Institute (NERI Technical Report No. 306; http://www2.dmu.dk/1_viden/2_publikationer/3_ fagrapporter/rapporter/fr306.pdf). 4. New York City Department of Health and Mental Hygiene (2019). Mercury in soaps and creams. New York, NYC Health (http://www1.nyc.gov/site/doh/ health/health-topics/mercury-in-soaps-and-creams. page). 5. McKelvey W, Jeffery N, Clark N, Kass D, Parsons PJ (2011). Population-based inorganic mercury biomonitoring and the identification of skin care products as a source of exposure in New York City. Environ Health Perspect, 119(2):203–209. 6. Engler DE (2005). Mercury “bleaching” creams. J Am Acad Dermatol, 52(6):1113–1114. 7. IPCS (2003). Elemental mercury and inorganic mercury compounds: human health aspects. Geneva, World Health Organization, International Programme on Chemical Safety (Concise International Chemical Assessment Document 50; http://www.who.int/ entity/ipcs/publications/cicad/en/cicad50.pdf). 8. UNEP (2019). Text and Annexes. Minamata Convention on Mercury. Nairobi, United Nations Environment Programme (http://www. mercuryconvention.org/Convention/Text/tabid/3426/ language/en-US/Default.aspx). 9. U.S. FDA (2019). FDA’s testing of cosmetics for arsenic, cadmium, chromium, cobalt, lead, mercury, and nickel content. Silver Spring, United States Food and Drug Administration (https://www.fda.gov/ cosmetics/potential-contaminants-cosmetics/ fdas-testing-cosmetics-arsenic-cadmium- chromium-cobalt-lead-mercury-and-nickel-content). 10. Sun GF, Hu WT, Yuan ZH, Zhang BA, Lu H (2017). Characteristics of mercury intoxication induced by skin-lightening products. Chin Med J (Engl), 130(24):3003–3004. 11. Uram E, Bischofer BP, Hagemann S (2010). Market analysis of some mercury-containing products and their mercury-free alternatives in selected regions. Gesellschaft für Anlagenund Reaktorsicherheit (GRS) mbH, March (GRS-253) (http://ipen.org/sites/ default/files/documents/market_analysis_mercury- containing_products_alternatives-en.pdf). 12. UNEP (2019). Minamata Convention Initial Assessments (MIAs). Nairobi: United Nations Environment Programme (http://www.mercuryconvention.org/Implementation/ MinamataInitialAssessments/tabid/6166/language/ en-US/Default.aspx). 4 13. Peltzer K, Pengpid S, James C (2016). The globalization of whitening: prevalence of skin lighteners (or bleachers) use and its social correlates among university students in 25 countries. Int J Dermatol, 55(2):165–172. 14. Shroff H, Diedrichs PC, Craddock N (2018). Skin color, culture capital, and beauty products: an investigation of the use of skin fairness products in Mumbai, India. Front Public Health, 5:1–9. 15. EEB ZMWG (2018). Mercury-added skin-lightening creams. Available, inexpensive, and toxic. Brussels, European Environmental Bureau. Zero Mercury Working Group (https://eeb.org/publications/59/industry- health/95798/report-mercury-added-skin-lightening- creams-available-inexpensive-and-toxic.pdf). 16. RAPEX (2009). The Rapid Alert System for Dangerous Non-Food Products, 2009 week 49, No. 8, Alert number 1625/09 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=1625/09). 17. U.S. FDA (2019). Import Alert No. 66-41: Detention without physical examination of unapproved new drugs promoted in the U.S. Silver Spring, United States Food and Drug Administration (http://www. accessdata.fda.gov/cms_ia/importalert_190.html). 18. U.S. FDA (2019). Import Alert 53-18: Detention without physical examination of skin whitening creams containing mercury. Silver Spring, United States Food and Drug Administration (http://www. accessdata.fda.gov/cms_ia/importalert_137.html). 19. RAPEX (2006). The Rapid Alert System for Dangerous Non-Food Products, 2006 week 24, No. 16, Alert number 0356/06 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0356/06). 20. Peregrino CP, Moreno MV, Miranda SV, Rubio AD, Leal LO (2011). Mercury levels in locally manufactured Mexican skin-lightening creams. Int J Environ Res Public Health, 8(6):2516–2523. 21. RAPEX (2011). The Rapid Alert System for Dangerous Non-Food Products, 2011 week 31, No. 33, Alert number 0461/11 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0461/11). 22. RAPEX (2007). The Rapid Alert System for Dangerous Non-Food Products, 2007 week 29, No. 22, Alert number 0732/07 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0732/07). 23. RAPEX (2009). The Rapid Alert System for Dangerous Non-Food Products, 2009 week 28, No. 3, Alert number 0954/09 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0954/09). 24. Republic of the Philippines Food and Drug Administration (2011). List of cosmetic products found to contain mercury exceeding the allowable limit of 1ppm. Manila, Department of Health (https://www.doh.gov.ph/Health-Alerts/List-of- Cosmetic-Products-Found-to-Contain-Mercury- Exceeding-the-Allowable-Limit-of-1ppm). 25. RAPEX (2006). The Rapid Alert System for Dangerous Non-Food Products, 2006 week 31, No. 13, Alert number 0491/06 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0491/06). 26. U.S. FDA (2016). Mercury poisoning linked to skin products. Silver Spring, United States Food and Drug Administration (https://www.fda.gov/consumers/ consumer-updates/mercury-poisoning-linked-skin- products). 27. MDH (2016). Skin-lightening products found to contain mercury. St. Paul, Minnesota Department of Health (https://www.health.state.mn.us/ communities/environment/skin/). 28. CDPH (n.d.). Face creams containing mercury. Sacramento, California Department of Public Health. Environmental Health Investigations Branch (https://www.cdph.ca.gov/Programs/CCDPHP/ DEODC/EHIB/CPE/CDPH%20Document%20Library/ Word%20Creams%20Doc_FINAL_ADA.pdf). 29. Bell L, DiGangi J, Weinberg J (2014). An NGO introduction to mercury pollution and the Minamata Convention on Mercury. Gothenburg, International POPs Elimination Network (https://ipen.org/sites/ default/files/documents/ipen-booklet-hg-update- v1_6-en-2-web.pdf). 30. Jose A, Ray JG (2018). Toxic content of certain commercially available fairness creams in Indian market. Cogent Med, 5(1):1433104. 31. Ladizinski B, Mistry N, Kundu RV (2011). Widespread use of toxic skin lightening compounds: medical and psychosocial aspects. Dermatol Clin, 29(1):111–123. 32. Al-Saleh I, Al-Doush I (1997). Mercury content in skin-lightening creams and potential hazards to the health of Saudi women. J Toxicol Environ Health, 51(2):123–130. 5 WHO/CED/PHE/EPE/19.13 © World Health Organization 2019 Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damage arising from its use. This is an update of the information sheet with the same title published in 2011, which was financially supported by the German Ministry of Environment, Nature Conservation and Nuclear Safety. Department of Public Health, Environmental and Social Determinants of Health World Health Organization 20 Avenue Appia, 1211 Geneva 27, Switzerland 33. UNEP (2019). Lists of mercury compounds and mercury-added products. UNEP/MC/COP.3/INF/18. In: Information Documents from the Third Meeting of the Conference of the Parties to the Minamata Convention on Mercury (COP3). Nairobi, United Nations Environment Programme (document available for download from: http://www. mercuryconvention.org/Meetings/COP3). 34. ATSDR (1999). Toxicological profile for mercury. Atlanta, Agency for Toxic Substances & Disease Registry (http://www.atsdr.cdc.gov/toxprofiles/TP. asp?id=115&tid=24). 35. WHO (2007). Exposure to mercury: a major public health concern. Geneva, World Health Organization (Preventing disease through healthy environments series; http://www.who.int/phe/news/Mercury-flyer.pdf). 36. WHO (2017). Mercury and health. Key facts. Geneva, World Health Organization (https://who.int/news- room/fact-sheets/detail/mercury-and-health). 37. Tang HL, Chu KH, Mak YF, Lee W, Cheuk A, Yim KF, et al. (2006). Minimal change disease following exposure to mercury-containing skin lightening cream. Hong Kong Med J, 12(4):316–318. 38. Zellner T, Zellner N, Felgenhauer N, Eyer F (2016). Dementia, epilepsy, and polyneuropathy in a mercury-exposed patient: investigation, identification of an obscure source of treatment. BMJ Case Rep, 2016:bcr2016216835. 39. Barr RD, Rees PH, Cordy PE, Kungu A, Woodger BA, Cameron HM (1972). Nephrotic syndrome in adult Africans in Nairobi. Br Med J, 2(5806):131–134. 40. BRI (2018). Phasing out mercury-added products: skin lightening products and other cosmetics. Portland, Biodiversity Research Institute (http://www.briloon.org/uploads/BRI_Documents/ Mercury_Center/UNEP%20Projects/2019/FOR%20 WEB%20Global%20Cosmetics%20Flyer%20 revised%202019.pdf). 41. UNEP (2019). Exemptions Under the Minamata Convention on Mercury. Nairobi, United Nations Environment Programme. (http://www.mercuryconvention.org/Countries/ Parties/Exemptions/tabid/5967/language/en-US/ Default.aspx). 42. IPCS (1991). Mercury-containing cream and soap. In: Inorganic mercury. Geneva, World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 118; (http://www.inchem.org/documents/ehc/ehc/ehc118. htm#SectionNumber:3.5). 43. European Commission (2019). Annex V. List of preservatives allowed in cosmetic products. In: Regulation (EC) No. 1223/2009 of the European Parliament and of the Council. Updated July 11, 2019. Brussels, The European Commission (http://ec.europa.eu/growth/tools-databases/cosing/ pdf/COSING_Annex%20V_v2.pdf). 44. Health Canada (2012). Guidance on heavy metal impurities in cosmetics. Ottawa, Health Canada (http://www.hc-sc.gc.ca/cps-spc/pubs/indust/ heavy_metals-metaux_lourds/index-eng.php). 45. U.S. FDA (2019). CFR – Code of Federal Regulations Title 21. Chapter I: Food and Drug Administration. Subchapter G: Cosmetics. Silver Spring, United States Department Food and Drug Administration (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/ cfCFR/CFRSearch. cfm?fr=700.13&SearchTerm=mercury).
MERCURY IN SKIN LIGHTENING PRODUCTS PREVENTING DISEASE THROUGH HEALTHY ENVIRONMENTS Mercury is a common but dangerous ingredient found in skin lightening creams and soaps. Beauty standards promoted by media, advertising and marketing reinforce the bias that lighter skin tone is more desirable than darker skin tone. Skin lightening creams and soaps are commonly used in many African, Asian and Caribbean nations (1, 2). They are also used among dark-skinned populations in Europe and North America (3–5). Mercury salts inhibit the formation of melanin, resulting in a lighter skin tone (6, 7). The Minamata Convention on Mercury establishes a limit of 1 mg/kg (1 ppm) for skin lightening products (8), yet many cosmetic products contain mercury levels higher than that amount to increase whitening effect (9, 10). Despite having been banned in many countries, mercury-containing products are often easily obtainable (11). Mercury can be eliminated from skin lightening products by working with health and environmental ministries and raising public awareness about the dangers to health from mercury and other hazardous chemicals in skin lightening products. To stop the manufacture, import and export of skin lightening products in line with the Minamata Convention, regulatory actions by governments are needed – including training of customs agents – as well as major media and advocacy campaigns. Use, production and availability • Skin lightening products are used worldwide, but their use is particularly widespread in many African, Asian and Caribbean countries (1, 12). Skin lightening products are used by both women and men (13). • The skin lightening industry is one of the fastest growing beauty industries worldwide and is estimated to be worth US$ 31.2 billion by 2024 (14). In India, for example, the skin lightening industry (including products with and without mercury) represents 50% of the skincare market and is estimated to be worth US$ 450–535 million (14). • Mercury-containing skin lightening products are manufactured in many countries and areas, including Bangladesh (15), China (16, 17), Dominican Republic (18), Hong Kong SAR (China) (15), Jamaica (15), Lebanon (19), Malaysia (15), Mexico (17, 20), Pakistan (21), Philippines (22), Republic of Korea (15), Thailand (23, 24), and the United States of America (25). • Mercury-containing skin lightening products are available for sale over the Internet, promoted online on social media sites, and sold through mobile apps. According to the United States Food and Drug Administration (FDA), these products are often manufactured abroad and sold illegally in the United States, often in small shops and informal markets catering to Latino, Asian, African or Middle Eastern communities. Consumers also purchase them in other countries and bring them back to their country (26). The toxic trade of often illegal mercury-added skin lightening products is a global crisis expected to only worsen with skyrocketing demand, especially in Africa, Asia and the Middle East (15). • A 2011 survey funded by the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety noted that individuals from Brazil, Kyrgyzstan, Mexico and the Russian Federation believe that mercury-containing skin lightening products are easy to obtain (11). • A study conducted by the Zero Mercury Group in 2017 and 2018 collected 338 samples of skin lightening creams from 22 countries in both formal and informal markets to identify a “snapshot” of the frequency and concentrations where mercury is used as an active ingredient in skin lightening creams worldwide. Thirty-four creams (10% of the samples) were found to have high mercury levels, i.e. above 1 ppm. These high mercury samples were found in seven of the 22 countries. Of these seven countries, four had requirements prohibiting more than 1 ppm mercury content. Overall, the mercury concentrations in these particular products ranged from 93 ppm to over 16 000 ppm (15). Other studies have found even higher concentrations of mercury in skin lightening products (27). • Since 2010, the California Department of Public Health’s Environmental Health Investigations Branch (EHIB) has conducted investigations of poisonings involving mercury in blemish and spot-removing face cream products. They have found a variety of mercury-containing products from Cambodia, China, Japan, Mexico, Pakistan and the Philippines. The EHIB determined that some of the products caused serious health problems, including health problems that required hospitalization (28). • Many countries have enacted legislation banning mercury-containing cosmetics, but many others have not. Despite legislation prohibiting mercury- containing products, their availability remains a problem (29). Even where distribution is banned, mercury-containing products are often still easily obtainable (11). • Skin lightening products that do not contain mercury may contain other hazardous substances, such as hydroquinone. In places where skin lightening products are used, consumers may be unaware of the harmful effects of the chemicals in these products (30). Products, packaging and ingredients • Skin lightening products come in different forms, including creams and soaps. The soap may be sold as “antiseptic soap” (3). These products are supposed to be applied to the skin to dry overnight (3). Both women and men use the soap to wash their hair, arms, face or entire body (3). It is reported that some individuals have used these products for decades (1). • The soaps, which are sold in stores and online, come in bar form and are sold individually in boxes (4). The creams are generally packaged in tubes or jars (4). The soaps contain approximately 1–3% mercury iodide and the creams are composed of 1–10% mercury ammonium (3). Some soap products that have been tested contained mercury at concentrations up to 31 mg/kg (31 ppm), whereas some cream products have been found to have mercury concentrations as high as 33 000 mg/kg (33 000 ppm) (27). The Minamata Convention establishes a limit of 1 mg/kg (1 ppm) for skin lightening products, yet many cosmetic products contain mercury levels higher than 1 mg/kg (1 ppm) to increase whitening effect (9, 10). • The amount or concentration of mercury in a product may be labelled on the packaging or listed in the ingredients list. Names to look for include: mercury, Hg, mercuric iodide, mercury oxide, mercurous chloride, ethyl mercury, phenyl mercuric salts, ammoniated mercury, amide chloride of mercury, mercury iodide, or “poison”. Directions to avoid contact with silver, gold, rubber, aluminium and jewellery may also indicate the presence of mercury (3, 4, 26, 31–33). Of great concern is that companies selling products containing mercury do not always list it as an ingredient. Other cosmetics containing mercury • Mercury may also be found in cosmetics for the eye area, such as mascara, and in eye makeup cleansing products, where it is used as a preservative (1, 3, 31). • Mercury in cosmetics exists in two forms: inorganic and organic (31, 34, 35). Inorganic mercury is used in skin lightening creams and soaps. Organic mercury compounds (e.g. thiomersal, which contains ethyl mercury, and phenyl mercuric salts) are used as cosmetic preservatives in eye makeup, including mascara, and in eye makeup cleansing products (3, 31–33). These forms of mercury differ in their degree of toxicity, and have varying effects on the nervous, digestive and immune systems, as well as the lungs, kidneys, skin and eyes (36). • The Minamata Convention does not establish a limit for eye area cosmetics where mercury is used as a preservative, and no effective and safe substitutes are available (8). 2 Health effects • Adverse health effects of the inorganic mercury contained in skin lightening creams and soaps include: kidney damage (7), skin rashes, skin discolouration and scarring, reduction in the skin’s resistance to bacterial and fungal infections (31), anxiety, depression, psychosis and peripheral neuropathy (3, 31). • The medical literature reports specific instances of individuals suffering from the aforementioned health effects following exposure to mercury through skin lightening creams and soaps. One case report describes a 34-year-old Chinese woman who developed nephrotic syndrome, a condition marked by high levels of protein in the urine. Nephrotic syndrome can be associated with a series of complications that affect an individual’s health and quality of life. The mercury levels in the woman’s blood and urine returned to normal one month and nine months, respectively, after she stopped using the skin lightening cream (37). Another case report describes a 54-year-old woman with an onset of dementia, epilepsy and peripheral polyneuropathy at the age of 49. After six years of daily skin lightening cream application, exposure was stopped immediately, after which her blood and urine mercury levels returned to unexposed levels (38). • One study revealed a large proportion of nephrotic syndrome among African women using ammoniated mercuric chloride–containing skin lightening creams for periods ranging from one month to three years. After cessation of mercury-containing skin lightening creams, urine mercury levels rapidly fell to within the unexposed range. Over three quarters of the women who stopped using the creams went into remission (7, 39). • Mercury in soaps, creams and other cosmetic products is eventually discharged into waste water. The mercury then enters the environment, where it becomes methylated and can enter the food chain as highly toxic methylmercury in fish (3). Pregnant women who consume fish containing methylmercury can transfer the mercury to their fetuses, which can result in neurodevelopmental deficits in the children (3). • Exposure to inorganic mercury can be quantified through measurements in blood and urine (34). Regulations • The Minamata Convention on Mercury is a global treaty “to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds” (8). It entered into force on 16 August 2017 and as of November 2019, 114 countries had ratified the Convention. After 2020, Parties to the Convention are required to have banned the manufacture, import and export of “Cosmetics (with mercury content above 1 ppm), including skin lightening soaps and creams, and not including eye area cosmetics where mercury is used as a preservative and no effective and safe substitute preservatives are available” except where the Party has registered an exemption to 2025 (8, 40). As of November 2019, a number of Parties had registered such an exemption (8, 41). The intention of the Convention is not to cover cosmetics, soaps or creams with trace contaminants of mercury (8). • The European Union (42, 43) and many other countries have regulations banning mercury-containing cosmetics. These include Canada (44), Philippines (24) and the United States (45), as well as a number of African nations (11), including Ghana, Nigeria and Uganda (12). Actions needed • To protect the public from negative health effects of mercury in skin lightening products, actions are needed that engage different parts of society, such as, but not limited to: establishing or improving legislation; implementing compliance and enforcement strategies for legislation, including training for customs agents and identification of manufacturers and supply chains; strengthening laboratory capacity to test for mercury in skin lightening products; conducting advocacy campaigns run by national health authorities, and public awareness campaigns to inform consumers about the health risks of skin lightening products, including those containing mercury; and increasing awareness among health professionals of health risks associated with skin lightening products, including those containing mercury, to inform and educate patients and the community. 3 Conclusions • Mercury-containing skin lightening products are hazardous to health and as a result have been banned in many countries. Even in some countries where such products have been banned, they are still advertised and available to consumers via the Internet and other means. • There is a great need for public awareness given the worldwide increase in the use of cosmetic products containing mercury. • Information on the hazards of skin lightening products in general must be provided to consumers as even skin lightening products that do not contain mercury may contain other hazardous substances, such as hydroquinone. For further WHO information on mercury, please visit: https://www.who.int/health-topics/chemical-safety References 1. Dadzie OE, Petit AJ (2009). Skin bleaching: highlighting the misuse of cutaneous depigmenting agents. Eur Acad Dermatol Venereol, 23(7):741–750. 2. WHO (2008). Guidance for identifying populations at risk from mercury exposure. Geneva, World Health Organization (http://www.who.int/foodsafety/ publications/chem/mercuryexposure.pdf). 3. Glahder CM, Appel PWU, Asmund G (1999). Mercury in soap in Tanzania. Copenhagen, Ministry of Environment and Energy, National Environmental Research Institute (NERI Technical Report No. 306; http://www2.dmu.dk/1_viden/2_publikationer/3_ fagrapporter/rapporter/fr306.pdf). 4. New York City Department of Health and Mental Hygiene (2019). Mercury in soaps and creams. New York, NYC Health (http://www1.nyc.gov/site/doh/ health/health-topics/mercury-in-soaps-and-creams. page). 5. McKelvey W, Jeffery N, Clark N, Kass D, Parsons PJ (2011). Population-based inorganic mercury biomonitoring and the identification of skin care products as a source of exposure in New York City. Environ Health Perspect, 119(2):203–209. 6. Engler DE (2005). Mercury “bleaching” creams. J Am Acad Dermatol, 52(6):1113–1114. 7. IPCS (2003). Elemental mercury and inorganic mercury compounds: human health aspects. Geneva, World Health Organization, International Programme on Chemical Safety (Concise International Chemical Assessment Document 50; http://www.who.int/ entity/ipcs/publications/cicad/en/cicad50.pdf). 8. UNEP (2019). Text and Annexes. Minamata Convention on Mercury. Nairobi, United Nations Environment Programme (http://www. mercuryconvention.org/Convention/Text/tabid/3426/ language/en-US/Default.aspx). 9. U.S. FDA (2019). FDA’s testing of cosmetics for arsenic, cadmium, chromium, cobalt, lead, mercury, and nickel content. Silver Spring, United States Food and Drug Administration (https://www.fda.gov/ cosmetics/potential-contaminants-cosmetics/ fdas-testing-cosmetics-arsenic-cadmium- chromium-cobalt-lead-mercury-and-nickel-content). 10. Sun GF, Hu WT, Yuan ZH, Zhang BA, Lu H (2017). Characteristics of mercury intoxication induced by skin-lightening products. Chin Med J (Engl), 130(24):3003–3004. 11. Uram E, Bischofer BP, Hagemann S (2010). Market analysis of some mercury-containing products and their mercury-free alternatives in selected regions. Gesellschaft für Anlagenund Reaktorsicherheit (GRS) mbH, March (GRS-253) (http://ipen.org/sites/ default/files/documents/market_analysis_mercury- containing_products_alternatives-en.pdf). 12. UNEP (2019). Minamata Convention Initial Assessments (MIAs). Nairobi: United Nations Environment Programme (http://www.mercuryconvention.org/Implementation/ MinamataInitialAssessments/tabid/6166/language/ en-US/Default.aspx). 4 13. Peltzer K, Pengpid S, James C (2016). The globalization of whitening: prevalence of skin lighteners (or bleachers) use and its social correlates among university students in 25 countries. Int J Dermatol, 55(2):165–172. 14. Shroff H, Diedrichs PC, Craddock N (2018). Skin color, culture capital, and beauty products: an investigation of the use of skin fairness products in Mumbai, India. Front Public Health, 5:1–9. 15. EEB ZMWG (2018). Mercury-added skin-lightening creams. Available, inexpensive, and toxic. Brussels, European Environmental Bureau. Zero Mercury Working Group (https://eeb.org/publications/59/industry- health/95798/report-mercury-added-skin-lightening- creams-available-inexpensive-and-toxic.pdf). 16. RAPEX (2009). The Rapid Alert System for Dangerous Non-Food Products, 2009 week 49, No. 8, Alert number 1625/09 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=1625/09). 17. U.S. FDA (2019). Import Alert No. 66-41: Detention without physical examination of unapproved new drugs promoted in the U.S. Silver Spring, United States Food and Drug Administration (http://www. accessdata.fda.gov/cms_ia/importalert_190.html). 18. U.S. FDA (2019). Import Alert 53-18: Detention without physical examination of skin whitening creams containing mercury. Silver Spring, United States Food and Drug Administration (http://www. accessdata.fda.gov/cms_ia/importalert_137.html). 19. RAPEX (2006). The Rapid Alert System for Dangerous Non-Food Products, 2006 week 24, No. 16, Alert number 0356/06 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0356/06). 20. Peregrino CP, Moreno MV, Miranda SV, Rubio AD, Leal LO (2011). Mercury levels in locally manufactured Mexican skin-lightening creams. Int J Environ Res Public Health, 8(6):2516–2523. 21. RAPEX (2011). The Rapid Alert System for Dangerous Non-Food Products, 2011 week 31, No. 33, Alert number 0461/11 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0461/11). 22. RAPEX (2007). The Rapid Alert System for Dangerous Non-Food Products, 2007 week 29, No. 22, Alert number 0732/07 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0732/07). 23. RAPEX (2009). The Rapid Alert System for Dangerous Non-Food Products, 2009 week 28, No. 3, Alert number 0954/09 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0954/09). 24. Republic of the Philippines Food and Drug Administration (2011). List of cosmetic products found to contain mercury exceeding the allowable limit of 1ppm. Manila, Department of Health (https://www.doh.gov.ph/Health-Alerts/List-of- Cosmetic-Products-Found-to-Contain-Mercury- Exceeding-the-Allowable-Limit-of-1ppm). 25. RAPEX (2006). The Rapid Alert System for Dangerous Non-Food Products, 2006 week 31, No. 13, Alert number 0491/06 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0491/06). 26. U.S. FDA (2016). Mercury poisoning linked to skin products. Silver Spring, United States Food and Drug Administration (https://www.fda.gov/consumers/ consumer-updates/mercury-poisoning-linked-skin- products). 27. MDH (2016). Skin-lightening products found to contain mercury. St. Paul, Minnesota Department of Health (https://www.health.state.mn.us/ communities/environment/skin/). 28. CDPH (n.d.). Face creams containing mercury. Sacramento, California Department of Public Health. Environmental Health Investigations Branch (https://www.cdph.ca.gov/Programs/CCDPHP/ DEODC/EHIB/CPE/CDPH%20Document%20Library/ Word%20Creams%20Doc_FINAL_ADA.pdf). 29. Bell L, DiGangi J, Weinberg J (2014). An NGO introduction to mercury pollution and the Minamata Convention on Mercury. Gothenburg, International POPs Elimination Network (https://ipen.org/sites/ default/files/documents/ipen-booklet-hg-update- v1_6-en-2-web.pdf). 30. Jose A, Ray JG (2018). Toxic content of certain commercially available fairness creams in Indian market. Cogent Med, 5(1):1433104. 31. Ladizinski B, Mistry N, Kundu RV (2011). Widespread use of toxic skin lightening compounds: medical and psychosocial aspects. Dermatol Clin, 29(1):111–123. 32. Al-Saleh I, Al-Doush I (1997). Mercury content in skin-lightening creams and potential hazards to the health of Saudi women. J Toxicol Environ Health, 51(2):123–130. 5 WHO/CED/PHE/EPE/19.13 © World Health Organization 2019 Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damage arising from its use. This is an update of the information sheet with the same title published in 2011, which was financially supported by the German Ministry of Environment, Nature Conservation and Nuclear Safety. Department of Public Health, Environmental and Social Determinants of Health World Health Organization 20 Avenue Appia, 1211 Geneva 27, Switzerland 33. UNEP (2019). Lists of mercury compounds and mercury-added products. UNEP/MC/COP.3/INF/18. In: Information Documents from the Third Meeting of the Conference of the Parties to the Minamata Convention on Mercury (COP3). Nairobi, United Nations Environment Programme (document available for download from: http://www. mercuryconvention.org/Meetings/COP3). 34. ATSDR (1999). Toxicological profile for mercury. Atlanta, Agency for Toxic Substances & Disease Registry (http://www.atsdr.cdc.gov/toxprofiles/TP. asp?id=115&tid=24). 35. WHO (2007). Exposure to mercury: a major public health concern. Geneva, World Health Organization (Preventing disease through healthy environments series; http://www.who.int/phe/news/Mercury-flyer.pdf). 36. WHO (2017). Mercury and health. Key facts. Geneva, World Health Organization (https://who.int/news- room/fact-sheets/detail/mercury-and-health). 37. Tang HL, Chu KH, Mak YF, Lee W, Cheuk A, Yim KF, et al. (2006). Minimal change disease following exposure to mercury-containing skin lightening cream. Hong Kong Med J, 12(4):316–318. 38. Zellner T, Zellner N, Felgenhauer N, Eyer F (2016). Dementia, epilepsy, and polyneuropathy in a mercury-exposed patient: investigation, identification of an obscure source of treatment. BMJ Case Rep, 2016:bcr2016216835. 39. Barr RD, Rees PH, Cordy PE, Kungu A, Woodger BA, Cameron HM (1972). Nephrotic syndrome in adult Africans in Nairobi. Br Med J, 2(5806):131–134. 40. BRI (2018). Phasing out mercury-added products: skin lightening products and other cosmetics. Portland, Biodiversity Research Institute (http://www.briloon.org/uploads/BRI_Documents/ Mercury_Center/UNEP%20Projects/2019/FOR%20 WEB%20Global%20Cosmetics%20Flyer%20 revised%202019.pdf). 41. UNEP (2019). Exemptions Under the Minamata Convention on Mercury. Nairobi, United Nations Environment Programme. (http://www.mercuryconvention.org/Countries/ Parties/Exemptions/tabid/5967/language/en-US/ Default.aspx). 42. IPCS (1991). Mercury-containing cream and soap. In: Inorganic mercury. Geneva, World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 118; (http://www.inchem.org/documents/ehc/ehc/ehc118. htm#SectionNumber:3.5). 43. European Commission (2019). Annex V. List of preservatives allowed in cosmetic products. In: Regulation (EC) No. 1223/2009 of the European Parliament and of the Council. Updated July 11, 2019. Brussels, The European Commission (http://ec.europa.eu/growth/tools-databases/cosing/ pdf/COSING_Annex%20V_v2.pdf). 44. Health Canada (2012). Guidance on heavy metal impurities in cosmetics. Ottawa, Health Canada (http://www.hc-sc.gc.ca/cps-spc/pubs/indust/ heavy_metals-metaux_lourds/index-eng.php). 45. U.S. FDA (2019). CFR – Code of Federal Regulations Title 21. Chapter I: Food and Drug Administration. Subchapter G: Cosmetics. Silver Spring, United States Department Food and Drug Administration (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/ cfCFR/CFRSearch. cfm?fr=700.13&SearchTerm=mercury).
MERCURY IN SKIN LIGHTENING PRODUCTS PREVENTING DISEASE THROUGH HEALTHY ENVIRONMENTS Mercury is a common but dangerous ingredient found in skin lightening creams and soaps. Beauty standards promoted by media, advertising and marketing reinforce the bias that lighter skin tone is more desirable than darker skin tone. Skin lightening creams and soaps are commonly used in many African, Asian and Caribbean nations (1, 2). They are also used among dark-skinned populations in Europe and North America (3–5). Mercury salts inhibit the formation of melanin, resulting in a lighter skin tone (6, 7). The Minamata Convention on Mercury establishes a limit of 1 mg/kg (1 ppm) for skin lightening products (8), yet many cosmetic products contain mercury levels higher than that amount to increase whitening effect (9, 10). Despite having been banned in many countries, mercury-containing products are often easily obtainable (11). Mercury can be eliminated from skin lightening products by working with health and environmental ministries and raising public awareness about the dangers to health from mercury and other hazardous chemicals in skin lightening products. To stop the manufacture, import and export of skin lightening products in line with the Minamata Convention, regulatory actions by governments are needed – including training of customs agents – as well as major media and advocacy campaigns. Use, production and availability • Skin lightening products are used worldwide, but their use is particularly widespread in many African, Asian and Caribbean countries (1, 12). Skin lightening products are used by both women and men (13). • The skin lightening industry is one of the fastest growing beauty industries worldwide and is estimated to be worth US$ 31.2 billion by 2024 (14). In India, for example, the skin lightening industry (including products with and without mercury) represents 50% of the skincare market and is estimated to be worth US$ 450–535 million (14). • Mercury-containing skin lightening products are manufactured in many countries and areas, including Bangladesh (15), China (16, 17), Dominican Republic (18), Hong Kong SAR (China) (15), Jamaica (15), Lebanon (19), Malaysia (15), Mexico (17, 20), Pakistan (21), Philippines (22), Republic of Korea (15), Thailand (23, 24), and the United States of America (25). • Mercury-containing skin lightening products are available for sale over the Internet, promoted online on social media sites, and sold through mobile apps. According to the United States Food and Drug Administration (FDA), these products are often manufactured abroad and sold illegally in the United States, often in small shops and informal markets catering to Latino, Asian, African or Middle Eastern communities. Consumers also purchase them in other countries and bring them back to their country (26). The toxic trade of often illegal mercury-added skin lightening products is a global crisis expected to only worsen with skyrocketing demand, especially in Africa, Asia and the Middle East (15). • A 2011 survey funded by the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety noted that individuals from Brazil, Kyrgyzstan, Mexico and the Russian Federation believe that mercury-containing skin lightening products are easy to obtain (11). • A study conducted by the Zero Mercury Group in 2017 and 2018 collected 338 samples of skin lightening creams from 22 countries in both formal and informal markets to identify a “snapshot” of the frequency and concentrations where mercury is used as an active ingredient in skin lightening creams worldwide. Thirty-four creams (10% of the samples) were found to have high mercury levels, i.e. above 1 ppm. These high mercury samples were found in seven of the 22 countries. Of these seven countries, four had requirements prohibiting more than 1 ppm mercury content. Overall, the mercury concentrations in these particular products ranged from 93 ppm to over 16 000 ppm (15). Other studies have found even higher concentrations of mercury in skin lightening products (27). • Since 2010, the California Department of Public Health’s Environmental Health Investigations Branch (EHIB) has conducted investigations of poisonings involving mercury in blemish and spot-removing face cream products. They have found a variety of mercury-containing products from Cambodia, China, Japan, Mexico, Pakistan and the Philippines. The EHIB determined that some of the products caused serious health problems, including health problems that required hospitalization (28). • Many countries have enacted legislation banning mercury-containing cosmetics, but many others have not. Despite legislation prohibiting mercury- containing products, their availability remains a problem (29). Even where distribution is banned, mercury-containing products are often still easily obtainable (11). • Skin lightening products that do not contain mercury may contain other hazardous substances, such as hydroquinone. In places where skin lightening products are used, consumers may be unaware of the harmful effects of the chemicals in these products (30). Products, packaging and ingredients • Skin lightening products come in different forms, including creams and soaps. The soap may be sold as “antiseptic soap” (3). These products are supposed to be applied to the skin to dry overnight (3). Both women and men use the soap to wash their hair, arms, face or entire body (3). It is reported that some individuals have used these products for decades (1). • The soaps, which are sold in stores and online, come in bar form and are sold individually in boxes (4). The creams are generally packaged in tubes or jars (4). The soaps contain approximately 1–3% mercury iodide and the creams are composed of 1–10% mercury ammonium (3). Some soap products that have been tested contained mercury at concentrations up to 31 mg/kg (31 ppm), whereas some cream products have been found to have mercury concentrations as high as 33 000 mg/kg (33 000 ppm) (27). The Minamata Convention establishes a limit of 1 mg/kg (1 ppm) for skin lightening products, yet many cosmetic products contain mercury levels higher than 1 mg/kg (1 ppm) to increase whitening effect (9, 10). • The amount or concentration of mercury in a product may be labelled on the packaging or listed in the ingredients list. Names to look for include: mercury, Hg, mercuric iodide, mercury oxide, mercurous chloride, ethyl mercury, phenyl mercuric salts, ammoniated mercury, amide chloride of mercury, mercury iodide, or “poison”. Directions to avoid contact with silver, gold, rubber, aluminium and jewellery may also indicate the presence of mercury (3, 4, 26, 31–33). Of great concern is that companies selling products containing mercury do not always list it as an ingredient. Other cosmetics containing mercury • Mercury may also be found in cosmetics for the eye area, such as mascara, and in eye makeup cleansing products, where it is used as a preservative (1, 3, 31). • Mercury in cosmetics exists in two forms: inorganic and organic (31, 34, 35). Inorganic mercury is used in skin lightening creams and soaps. Organic mercury compounds (e.g. thiomersal, which contains ethyl mercury, and phenyl mercuric salts) are used as cosmetic preservatives in eye makeup, including mascara, and in eye makeup cleansing products (3, 31–33). These forms of mercury differ in their degree of toxicity, and have varying effects on the nervous, digestive and immune systems, as well as the lungs, kidneys, skin and eyes (36). • The Minamata Convention does not establish a limit for eye area cosmetics where mercury is used as a preservative, and no effective and safe substitutes are available (8). 2 Health effects • Adverse health effects of the inorganic mercury contained in skin lightening creams and soaps include: kidney damage (7), skin rashes, skin discolouration and scarring, reduction in the skin’s resistance to bacterial and fungal infections (31), anxiety, depression, psychosis and peripheral neuropathy (3, 31). • The medical literature reports specific instances of individuals suffering from the aforementioned health effects following exposure to mercury through skin lightening creams and soaps. One case report describes a 34-year-old Chinese woman who developed nephrotic syndrome, a condition marked by high levels of protein in the urine. Nephrotic syndrome can be associated with a series of complications that affect an individual’s health and quality of life. The mercury levels in the woman’s blood and urine returned to normal one month and nine months, respectively, after she stopped using the skin lightening cream (37). Another case report describes a 54-year-old woman with an onset of dementia, epilepsy and peripheral polyneuropathy at the age of 49. After six years of daily skin lightening cream application, exposure was stopped immediately, after which her blood and urine mercury levels returned to unexposed levels (38). • One study revealed a large proportion of nephrotic syndrome among African women using ammoniated mercuric chloride–containing skin lightening creams for periods ranging from one month to three years. After cessation of mercury-containing skin lightening creams, urine mercury levels rapidly fell to within the unexposed range. Over three quarters of the women who stopped using the creams went into remission (7, 39). • Mercury in soaps, creams and other cosmetic products is eventually discharged into waste water. The mercury then enters the environment, where it becomes methylated and can enter the food chain as highly toxic methylmercury in fish (3). Pregnant women who consume fish containing methylmercury can transfer the mercury to their fetuses, which can result in neurodevelopmental deficits in the children (3). • Exposure to inorganic mercury can be quantified through measurements in blood and urine (34). Regulations • The Minamata Convention on Mercury is a global treaty “to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds” (8). It entered into force on 16 August 2017 and as of November 2019, 114 countries had ratified the Convention. After 2020, Parties to the Convention are required to have banned the manufacture, import and export of “Cosmetics (with mercury content above 1 ppm), including skin lightening soaps and creams, and not including eye area cosmetics where mercury is used as a preservative and no effective and safe substitute preservatives are available” except where the Party has registered an exemption to 2025 (8, 40). As of November 2019, a number of Parties had registered such an exemption (8, 41). The intention of the Convention is not to cover cosmetics, soaps or creams with trace contaminants of mercury (8). • The European Union (42, 43) and many other countries have regulations banning mercury-containing cosmetics. These include Canada (44), Philippines (24) and the United States (45), as well as a number of African nations (11), including Ghana, Nigeria and Uganda (12). Actions needed • To protect the public from negative health effects of mercury in skin lightening products, actions are needed that engage different parts of society, such as, but not limited to: establishing or improving legislation; implementing compliance and enforcement strategies for legislation, including training for customs agents and identification of manufacturers and supply chains; strengthening laboratory capacity to test for mercury in skin lightening products; conducting advocacy campaigns run by national health authorities, and public awareness campaigns to inform consumers about the health risks of skin lightening products, including those containing mercury; and increasing awareness among health professionals of health risks associated with skin lightening products, including those containing mercury, to inform and educate patients and the community. 3 Conclusions • Mercury-containing skin lightening products are hazardous to health and as a result have been banned in many countries. Even in some countries where such products have been banned, they are still advertised and available to consumers via the Internet and other means. • There is a great need for public awareness given the worldwide increase in the use of cosmetic products containing mercury. • Information on the hazards of skin lightening products in general must be provided to consumers as even skin lightening products that do not contain mercury may contain other hazardous substances, such as hydroquinone. For further WHO information on mercury, please visit: https://www.who.int/health-topics/chemical-safety References 1. Dadzie OE, Petit AJ (2009). Skin bleaching: highlighting the misuse of cutaneous depigmenting agents. Eur Acad Dermatol Venereol, 23(7):741–750. 2. WHO (2008). Guidance for identifying populations at risk from mercury exposure. Geneva, World Health Organization (http://www.who.int/foodsafety/ publications/chem/mercuryexposure.pdf). 3. Glahder CM, Appel PWU, Asmund G (1999). Mercury in soap in Tanzania. Copenhagen, Ministry of Environment and Energy, National Environmental Research Institute (NERI Technical Report No. 306; http://www2.dmu.dk/1_viden/2_publikationer/3_ fagrapporter/rapporter/fr306.pdf). 4. New York City Department of Health and Mental Hygiene (2019). Mercury in soaps and creams. New York, NYC Health (http://www1.nyc.gov/site/doh/ health/health-topics/mercury-in-soaps-and-creams. page). 5. McKelvey W, Jeffery N, Clark N, Kass D, Parsons PJ (2011). Population-based inorganic mercury biomonitoring and the identification of skin care products as a source of exposure in New York City. Environ Health Perspect, 119(2):203–209. 6. Engler DE (2005). Mercury “bleaching” creams. J Am Acad Dermatol, 52(6):1113–1114. 7. IPCS (2003). Elemental mercury and inorganic mercury compounds: human health aspects. Geneva, World Health Organization, International Programme on Chemical Safety (Concise International Chemical Assessment Document 50; http://www.who.int/ entity/ipcs/publications/cicad/en/cicad50.pdf). 8. UNEP (2019). Text and Annexes. Minamata Convention on Mercury. Nairobi, United Nations Environment Programme (http://www. mercuryconvention.org/Convention/Text/tabid/3426/ language/en-US/Default.aspx). 9. U.S. FDA (2019). FDA’s testing of cosmetics for arsenic, cadmium, chromium, cobalt, lead, mercury, and nickel content. Silver Spring, United States Food and Drug Administration (https://www.fda.gov/ cosmetics/potential-contaminants-cosmetics/ fdas-testing-cosmetics-arsenic-cadmium- chromium-cobalt-lead-mercury-and-nickel-content). 10. Sun GF, Hu WT, Yuan ZH, Zhang BA, Lu H (2017). Characteristics of mercury intoxication induced by skin-lightening products. Chin Med J (Engl), 130(24):3003–3004. 11. Uram E, Bischofer BP, Hagemann S (2010). Market analysis of some mercury-containing products and their mercury-free alternatives in selected regions. Gesellschaft für Anlagenund Reaktorsicherheit (GRS) mbH, March (GRS-253) (http://ipen.org/sites/ default/files/documents/market_analysis_mercury- containing_products_alternatives-en.pdf). 12. UNEP (2019). Minamata Convention Initial Assessments (MIAs). Nairobi: United Nations Environment Programme (http://www.mercuryconvention.org/Implementation/ MinamataInitialAssessments/tabid/6166/language/ en-US/Default.aspx). 4 13. Peltzer K, Pengpid S, James C (2016). The globalization of whitening: prevalence of skin lighteners (or bleachers) use and its social correlates among university students in 25 countries. Int J Dermatol, 55(2):165–172. 14. Shroff H, Diedrichs PC, Craddock N (2018). Skin color, culture capital, and beauty products: an investigation of the use of skin fairness products in Mumbai, India. Front Public Health, 5:1–9. 15. EEB ZMWG (2018). Mercury-added skin-lightening creams. Available, inexpensive, and toxic. Brussels, European Environmental Bureau. Zero Mercury Working Group (https://eeb.org/publications/59/industry- health/95798/report-mercury-added-skin-lightening- creams-available-inexpensive-and-toxic.pdf). 16. RAPEX (2009). The Rapid Alert System for Dangerous Non-Food Products, 2009 week 49, No. 8, Alert number 1625/09 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=1625/09). 17. U.S. FDA (2019). Import Alert No. 66-41: Detention without physical examination of unapproved new drugs promoted in the U.S. Silver Spring, United States Food and Drug Administration (http://www. accessdata.fda.gov/cms_ia/importalert_190.html). 18. U.S. FDA (2019). Import Alert 53-18: Detention without physical examination of skin whitening creams containing mercury. Silver Spring, United States Food and Drug Administration (http://www. accessdata.fda.gov/cms_ia/importalert_137.html). 19. RAPEX (2006). The Rapid Alert System for Dangerous Non-Food Products, 2006 week 24, No. 16, Alert number 0356/06 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0356/06). 20. Peregrino CP, Moreno MV, Miranda SV, Rubio AD, Leal LO (2011). Mercury levels in locally manufactured Mexican skin-lightening creams. Int J Environ Res Public Health, 8(6):2516–2523. 21. RAPEX (2011). The Rapid Alert System for Dangerous Non-Food Products, 2011 week 31, No. 33, Alert number 0461/11 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0461/11). 22. RAPEX (2007). The Rapid Alert System for Dangerous Non-Food Products, 2007 week 29, No. 22, Alert number 0732/07 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0732/07). 23. RAPEX (2009). The Rapid Alert System for Dangerous Non-Food Products, 2009 week 28, No. 3, Alert number 0954/09 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0954/09). 24. Republic of the Philippines Food and Drug Administration (2011). List of cosmetic products found to contain mercury exceeding the allowable limit of 1ppm. Manila, Department of Health (https://www.doh.gov.ph/Health-Alerts/List-of- Cosmetic-Products-Found-to-Contain-Mercury- Exceeding-the-Allowable-Limit-of-1ppm). 25. RAPEX (2006). The Rapid Alert System for Dangerous Non-Food Products, 2006 week 31, No. 13, Alert number 0491/06 (https://ec.europa.eu/consumers/ consumers_safety/safety_products/rapex/ alerts/?event=main.notification&search_ term=0491/06). 26. U.S. FDA (2016). Mercury poisoning linked to skin products. Silver Spring, United States Food and Drug Administration (https://www.fda.gov/consumers/ consumer-updates/mercury-poisoning-linked-skin- products). 27. MDH (2016). Skin-lightening products found to contain mercury. St. Paul, Minnesota Department of Health (https://www.health.state.mn.us/ communities/environment/skin/). 28. CDPH (n.d.). Face creams containing mercury. Sacramento, California Department of Public Health. Environmental Health Investigations Branch (https://www.cdph.ca.gov/Programs/CCDPHP/ DEODC/EHIB/CPE/CDPH%20Document%20Library/ Word%20Creams%20Doc_FINAL_ADA.pdf). 29. Bell L, DiGangi J, Weinberg J (2014). An NGO introduction to mercury pollution and the Minamata Convention on Mercury. Gothenburg, International POPs Elimination Network (https://ipen.org/sites/ default/files/documents/ipen-booklet-hg-update- v1_6-en-2-web.pdf). 30. Jose A, Ray JG (2018). Toxic content of certain commercially available fairness creams in Indian market. Cogent Med, 5(1):1433104. 31. Ladizinski B, Mistry N, Kundu RV (2011). Widespread use of toxic skin lightening compounds: medical and psychosocial aspects. Dermatol Clin, 29(1):111–123. 32. Al-Saleh I, Al-Doush I (1997). Mercury content in skin-lightening creams and potential hazards to the health of Saudi women. J Toxicol Environ Health, 51(2):123–130. 5 WHO/CED/PHE/EPE/19.13 © World Health Organization 2019 Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damage arising from its use. This is an update of the information sheet with the same title published in 2011, which was financially supported by the German Ministry of Environment, Nature Conservation and Nuclear Safety. Department of Public Health, Environmental and Social Determinants of Health World Health Organization 20 Avenue Appia, 1211 Geneva 27, Switzerland 33. UNEP (2019). Lists of mercury compounds and mercury-added products. UNEP/MC/COP.3/INF/18. In: Information Documents from the Third Meeting of the Conference of the Parties to the Minamata Convention on Mercury (COP3). Nairobi, United Nations Environment Programme (document available for download from: http://www. mercuryconvention.org/Meetings/COP3). 34. ATSDR (1999). Toxicological profile for mercury. Atlanta, Agency for Toxic Substances & Disease Registry (http://www.atsdr.cdc.gov/toxprofiles/TP. asp?id=115&tid=24). 35. WHO (2007). Exposure to mercury: a major public health concern. Geneva, World Health Organization (Preventing disease through healthy environments series; http://www.who.int/phe/news/Mercury-flyer.pdf). 36. WHO (2017). Mercury and health. Key facts. Geneva, World Health Organization (https://who.int/news- room/fact-sheets/detail/mercury-and-health). 37. Tang HL, Chu KH, Mak YF, Lee W, Cheuk A, Yim KF, et al. (2006). Minimal change disease following exposure to mercury-containing skin lightening cream. Hong Kong Med J, 12(4):316–318. 38. Zellner T, Zellner N, Felgenhauer N, Eyer F (2016). Dementia, epilepsy, and polyneuropathy in a mercury-exposed patient: investigation, identification of an obscure source of treatment. BMJ Case Rep, 2016:bcr2016216835. 39. Barr RD, Rees PH, Cordy PE, Kungu A, Woodger BA, Cameron HM (1972). Nephrotic syndrome in adult Africans in Nairobi. Br Med J, 2(5806):131–134. 40. BRI (2018). Phasing out mercury-added products: skin lightening products and other cosmetics. Portland, Biodiversity Research Institute (http://www.briloon.org/uploads/BRI_Documents/ Mercury_Center/UNEP%20Projects/2019/FOR%20 WEB%20Global%20Cosmetics%20Flyer%20 revised%202019.pdf). 41. UNEP (2019). Exemptions Under the Minamata Convention on Mercury. Nairobi, United Nations Environment Programme. (http://www.mercuryconvention.org/Countries/ Parties/Exemptions/tabid/5967/language/en-US/ Default.aspx). 42. IPCS (1991). Mercury-containing cream and soap. In: Inorganic mercury. Geneva, World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 118; (http://www.inchem.org/documents/ehc/ehc/ehc118. htm#SectionNumber:3.5). 43. European Commission (2019). Annex V. List of preservatives allowed in cosmetic products. In: Regulation (EC) No. 1223/2009 of the European Parliament and of the Council. Updated July 11, 2019. Brussels, The European Commission (http://ec.europa.eu/growth/tools-databases/cosing/ pdf/COSING_Annex%20V_v2.pdf). 44. Health Canada (2012). Guidance on heavy metal impurities in cosmetics. Ottawa, Health Canada (http://www.hc-sc.gc.ca/cps-spc/pubs/indust/ heavy_metals-metaux_lourds/index-eng.php). 45. U.S. FDA (2019). CFR – Code of Federal Regulations Title 21. Chapter I: Food and Drug Administration. Subchapter G: Cosmetics. Silver Spring, United States Department Food and Drug Administration (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/ cfCFR/CFRSearch. cfm?fr=700.13&SearchTerm=mercury).
РТУТЬ ВПРОДУКЦИИ ДЛЯ ОСВЕТЛЕНИЯ КОЖИ ПРОФИЛАКТИКА ЗАБОЛЕВАНИЙ ЗА СЧЕТ ЗДОРОВОЙ ОКРУЖАЮЩЕЙ СРЕДЫ Ртуть — обычный, но опасный компонент кремов и мыла для осветления кожи. Поощряемые СМИ стандарты красоты, реклама и маркетинг всячески подчеркивают, что светлые тона кожи предпочтительнее темных. Кремы и мыло для осветления кожи распространены среди жителей Азии, Африки и Карибского бассейна (1, 2). Ими также пользуются темнокожие популяции в Европе и Северной Америке (3–5). Соли ртути ингибируют образование меланина, что приводит к осветлению кожи (6,7). Минаматская конвенция о ртути устанавливает предельное содержание ее в продукции для осветления кожи на уровне 1 мг/кг (1 мд) (8), но во многих косметических средствах это содержание превышено с целью усиления отбеливающего эффекта (9,10). Несмотря на действующий во многих странах запрет, ртутьсодержащая продукция зачастую легкодоступна (11). Ртуть можно убрать из продукции для осветления кожи, работая с министерствами охраны окружающей среды и здравоохранения и повышая осведомленность общественности о том, чем ртуть опасна для здоровья, а также чем опасны другие химические вещества в продукции для осветления кожи. Чтобы прекратить изготовление, импорт и экспорт осветляющей косметики, как это предусмотрено Минаматской конвенцией, требуется ряд регулятивных действий со стороны правительств, включая обучение таможенных агентов, — а также участие крупнейших СМИ и проведение кампаний информационно- разъяснительного характера. Использование, производство и доступность • Осветляющая косметика используется повсюду, но особенно распространена она во многих странах Азии, Африки и Карибского бассейна (1, 12). Средства для осветления кожи используют как мужчины, так и женщины (13). • Производство осветляющей косметики — одно из наиболее быстрорастущих в отрасли, и ожидается, что к 2024 году капитализация сектора достигнет 31,2 миллиарда долларов США (14). Например, в Индии производство осветляющих средств (как содержащих ртуть, так и не содержащих ее) составляет 50% рынка средств по уходу за кожей и оценивается в 450–535 миллионов долларов США (14). • Содержащие ртуть средства для осветления кожи изготавливаются во многих странах и регионах, включая Бангладеш, (15) Доминиканскую Республику, (18) Китай, (16, 17) Ливан, (19) Малайзию, (15) Мексику, (17, 20) Пакистан, (21) Республику Корея, (15) Соединенные Штаты Америки, (25) Специальный административный район Гонконг (Китай), (15) Таиланд, (23, 24) Филиппины, (22) Ямайку. (15) • Содержащая ртуть продукция для осветления кожи доступна в интернете, рекламируется в социальных сетях и продается через мобильные приложения. Согласно данным Администрации по контролю за пищевыми продуктами и лекарствами США (FDA), такая продукция нередко изготавливается за границей и продается в США нелегально, часто — в маленьких магазинах и на неофициальных рынках, которые обслуживают общины латиноамериканцев и выходцев из Азии, Африки и стран Ближнего Востока. Потребители также покупают эти товары в других странах и привозят с собой (26). Торговля токсичными, зачастую незаконными средствами для осветления кожи, содержащими ртуть, — это кризис мирового масштаба, который будет только углубляться, учитывая стремительно растущий спрос, в особенности в Азии, Африке и на Ближнем Востоке (15). • Опрос, проведенный в 2011 году Федеральным министерством охраны окружающей среды, сохранения природы и ядерной безопасности Германии, показал, что жители Бразилии, Кыргызстана, Мексики и Российской Федерации считают, что содержащие ртуть средства для осветления кожи легкодоступны (11). • Исследование, проведенное группой «За полный запрет ртути» (Zero Mercury Group) в 2017 и 2018 годах, собрало 338 образцов отбеливающих кремов для кожи из 22 стран (как из официальных магазинов, так и из неофициальных), чтобы получить представление о том, как часто и в какой концентрации ртуть во всем мире используется в продукции для осветления кожи. Высокое содержание ртути (то есть более 1 мд) было обнаружено в тридцати четырех кремах (10% образцов). Такие образцы с высоким содержанием ртути были найдены в 7 из 22 стран. В четырех из этих семи стран действуют правила, запрещающие использовать ртуть в содержании свыше 1 мд. В целом содержание ртути в этих средствах варьировалось от 93 до 16 000 мд (15). В других исследованиях было обнаружено, что содержание ртути в средствах для осветления кожи еще выше (27). • С 2010 года Отдел расследований в области здравоохранения и окружающей среды Министерства здравоохранения Калифорнии (EIHB) проводил расследование случаев отравлений, вызванных наличием ртути в кремах для лица, предназначенных для удаления прыщей и пятен. Было обнаружено большое количество продукции, содержащей ртуть и происходящей из Камбоджи, Китая, Мексики, Пакистана, Филиппин и Японии. EIHB выяснил, что некоторые из этих средств вызывали серьезные нарушения здоровья, в том числе такие, которые требовали госпитализации (28). • Во многих странах принято законодательство, запрещающее ртутьсодержащую косметику, но далеко не во всех. Несмотря на законодательство, запрещающее продукцию, содержащую ртуть, доступность таких средств по-прежнему создает проблемы (29). Даже там, где их распространение запрещено, эти средства зачастую легкодоступны (11). • Продукция для осветления кожи, не содержащая ртути, может содержать другие опасные вещества, например, гидрохинон. Там, где осветляющая косметика широко используется, потребители могут даже ничего не подозревать об опасности воздействия химических веществ, содержащихся в такой продукции (30). Продукция, упаковка и ингредиенты • Продукция для осветления кожи выпускается в разных формах, включая кремы и мыло. Мыло может продаваться как «антисептическое» (3). Предполагается, что такие средства наносят на кожу на ночь (3). Мыло используют как женщины, так и мужчины для мытья волос, рук, лица или всего тела (3). Как сообщают, некоторые люди использовали такую продукцию десятилетиями (1). • Мыло, продаваемое в магазинах и через интернет, обычно расфасовано на куски и продается в индивидуальной упаковке (в коробках) (4). Кремы обычно расфасованы в банки или тубы (4). Мыло содержит 1–3% йодида ртути, а в состав кремов входит 1–10% аммиаката ртути (3). В некоторых видах мыла содержание ртути доходило до 31 мг/кг (31 мд), тогда как в некоторых кремах содержание ртути было до 33 000 мг/кг (33 000 мд) (27). Минаматская конвенция устанавливает предельно допустимый уровень ртути 1 мг/кг (1 мд) для продукции, предназначенной для осветления кожи, но содержание ртути во многих косметических средствах превышает этот показатель — чтобы получить более заметный эффект осветления (9, 10). • Количество или концентрация ртути в продукции может быть указана на упаковке или в списке ингредиентов. Названия могут быть такими: ртуть, Hg, йодид ртути, оксид ртути, хлористая ртуть, этилртуть, соли фенилртути, аммиачно-ртутные соли, амидхлорид ртути или просто «яд». О присутствии ртути может также говорить указание избегать контакта такого средства с серебром, золотом, каучуком, алюминием и ювелирными изделиями (3, 4, 26, 31–33). Большую озабоченность вызывает тот факт, что компании, продающие продукцию с содержанием ртути, далеко не всегда указывают ее в списке ингредиентов. 2 Другие косметические средства, содержащие ртуть • Ртуть также может входить в состав косметики, предназначенной для области вокруг глаз, например, туши, и средств для снятия макияжа — в качестве консерванта (1,3,31). • Ртуть в косметике присутствует в двух формах: органической и неорганической (31, 34, 35). Неорганическая ртуть используется в кремах и мыле для осветления кожи. Органические соединения ртути (такие как тиомерсал, содержащий этилртуть, и соли фенилртути) используются в качестве консервантов в косметике для глаз, в том числе в туши для ресниц, и в продукции для снятия макияжа (3, 31–33). Эти формы ртути различаются по токсичности и оказывают разное воздействие на нервную, пищеварительную и иммунную системы организма, а также на легкие, почки, кожу и глаза (36). • Минаматская конвенция не устанавливает предельно допустимое содержание ртути для косметических средств по уходу за областью вокруг глаз, где ртуть используется в качестве консерванта, а эффективные и безопасные консерванты- заменители отсутствуют (8). Воздействие на здоровье • Неблагоприятное воздействие на здоровье неорганической ртути, содержащейся в кремах и мыле для осветления кожи, включает поражение почек (7), сыпь, измерение цвета кожи и ее рубцевание, снижение устойчивости кожи в отношении бактериальных и грибковых инфекций (31), тревогу, депрессию, психозы и периферическую нейропатию (3, 31). • В медицинской литературе имеются сообщения о людях, страдающих вышеупомянутыми проблемами со здоровьем из-за воздействия ртути, содержавшейся в кремах и мыле для осветления кожи. В одном из сообщений идет речь о 34-летней жительнице Китая, у которой развился нефротический синдром, выражавшийся повышенным содержанием белка в моче. Нефротический синдром может быть связан с целым рядом осложнений, которые влияют на здоровье и качество жизни человека. Уровни ртути в крови и моче женщины вернулись в норму спустя, соответственно, один и девять месяцев после того, как она прекратила применять крем для осветления кожи (37). В другом сообщении речь шла о женщине 54 лет, у которой в 49 лет развилась деменция, эпилепсия и периферийная полинейропатия. Спустя шесть лет ежедневного применения крема для осветления кожи пациентка немедленно перестала пользоваться им, после чего уровни ртути в крови и моче постепенно вернулись к значениям, наблюдавшимся до начала применения косметики (38). • В одном из исследований была выявлена высокая частота нефротического синдрома у африканских женщин, которые использовали кремы для осветления кожи, содержавшие хлорид ртути-аммония, на протяжении разных сроков — от одного месяца до трех лет. После прекращения использования кремов для осветления кожи уровни ртути в моче быстро возвращались к значениям, наблюдаемым до начала применения ртутьсодержащих средств. Примерно у трех четвертей женщин, прекративших пользоваться кремами, наблюдалась ремиссия (7, 39). • Ртуть, содержащаяся в мыле, кремах и другой косметической продукции, обычно попадает в воду. Оттуда она поступает в окружающую среду, там метилируется и в виде высокотоксичной метилртути может через рыб попадать в пищевую цепочку (3). Беременные женщины, питающиеся рыбой, содержащей метилртуть, могут передавать ртуть плодам, что приводит к нейродегенеративным поражениям у детей (3). • Количественное воздействие неорганической ртути можно определить, измеряя ее уровни в крови и моче (34). Нормативные акты • Минаматская конвенция о ртути — это международное соглашение, принимаемое с целью «защиты здоровья человека и окружающей среды от антропогенной эмиссии и выбросов ртути и ртутьсодержащих соединений» (8). • Это соглашение вступило в силу 16 августа 2017 года, по состоянию на ноябрь 2019 года конвенцию ратифицировали 114 государств. После 2020 года участники конвенции должны будут запретить изготовление, импорт и экспорт 3 • «косметики (с содержанием ртути свыше 1 мд), включая кремы и мыло для осветления кожи и не включая косметику для ухода за областью глаз, в которой ртуть используется в качестве консерванта, для которого нет безопасной и эффективной замены». За исключением случаев, когда участники зарегистрировали исключение до 2025 года (8, 40). В ноябре 2019 года некоторые участники зарегистрировали такое исключение. (8, 41) Задача конвенции не распространяется на косметику, мыло и кремы со следовыми концентрациями ртути (8). • В Европейском Союзе (42, 43) и других странах имеются нормативные акты, запрещающие применять ртуть в косметике. К таким странам относятся Канада (44), США (45) и Филиппины (24), а также большое количество африканских национальных государств (11), в том числе Гана, Нигерия и Уганда (12). Необходимые меры • Для защиты общественности от отрицательного воздействия ртути, содержащейся в средствах для осветления кожи, нужны меры, к которым бы привлекались самые разные слои населения, в том числе: установление или улучшение законодательных норм; осуществление стратегий соблюдения и обеспечения действенности законодательства, в том числе обучение таможенных агентов и идентификация изготовителей и цепочек поставки; усиление лабораторных возможностей выявления ртути в средствах для осветления кожи; проведение кампаний просвещения общественности силами национальных органов здравоохранения с целью информировать потребителей о том, какие риски для здоровья представляет использование продукции для осветления кожи, в том числе содержащей ртуть; и повышение среди медицинских работников уровня осведомленности о том, какой риск для здоровья представляют осветляющие косметические средства, в том числе содержащие ртуть, чтобы они могли информировать и обучать своих пациентов и общественность. Выводы • Содержащие ртуть косметические средства для осветления кожи опасны для здоровья и потому запрещены во многих странах. Даже в тех странах, где действует такой запрет, они все еще рекламируются, и потребитель может их купить через интернет и другими способами. • Крайне необходимо осведомлять общественность, учитывая мировой рост потребления косметических средств, содержащих ртуть. • Необходимо предоставлять людям информацию об опасности применения средств для осветления кожи в целом, так как в состав косметики для осветления кожи, не содержащей ртуть, могут входить другие опасные вещества, например, гидрохинон. Дополнительную информацию ВОЗ относительно ртути можно получить здесь: https://www.who.int/health-topics/chemical-safety 4 5Список использованной литературы 1. Dadzie OE, Petit AJ (2009). Skin bleaching: highlighting the misuse of cutaneous depigmenting agents. Eur Acad Dermatol Venereol, 23(7):741–750. 2. WHO (2008). 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List of preservatives allowed in cosmetic products. принятая на Regulation (EC) No. 1223/2009 of the European Parliament and of the Council. Updated July 11, 2019. Brussels, The European Commission (http://ec.europa.eu/growth/tools-databases/cosing/ pdf/COSING_Annex%20V_v2.pdf). 44. Health Canada (2012). Guidance on heavy metal impurities in cosmetics. Ottawa, Health Canada (http:// www.hc-sc.gc.ca/cps-spc/pubs/indust/heavy_metals- metaux_lourds/index-eng.php). 45. U.S. FDA (2019). CFR – Code of Federal Regulations Title 21. Chapter I: Food and Drug Administration. Subchapter G: Cosmetics. Silver Spring, United States Department Food and Drug Administration (http://www. accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/ CFRSearch.cfm?fr=700.13&SearchTerm=mercury). 7 WHO/CED/PHE/EPE/19.13 © Всемирная организация здравоохранения, 2019. Некоторые права защищены. Данный документ распространяется на условиях лицензии CC BY-NC-SA 3.0 IGO. 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皮肤美白产品中的汞 通过卫生的环境预防疾病 汞是皮肤美白霜和香皂中的常见成分，但是具有危险性。 媒体、广告和市场营销推广的美容标准导致偏见加剧，人 们倾向于相信较浅的肤色比较深的肤色更有吸引力。在许 多非洲、亚洲和加勒比海国家中，人们常用美白霜和香 皂。(1, 2) 欧洲和北美的深色皮肤人群也使用它 们。(3–5) 汞盐会抑制黑色素的形成，从而淡化肤 色。(6, 7)《关于汞的水俣公约》对皮肤美白产品规定限 值为 1 mg/kg (1 ppm)。(8) 然而，为了增加美白效果， 许多化妆品中的汞含量均高于限量。(9, 10) 尽管许多国 家都已禁止，但是含汞产品却依然比比皆是。(11) 通过与卫生部和环境部合作，并且提高公众意识，使人们 了解美白产品中的汞和其他有害化学物质对健康的危害， 可以消除皮肤美白产品中的汞。为了停止制造、进口和出 口皮肤美白产品，遵守《水俣公约》，需要政府采取监管 措施，包括培训报关代理人以及开展大型媒体和宣传活 动。 使用、生产和供应情况 • 世界各地都在使用皮肤美白产品，但是在许多非洲、 亚洲和加勒比海国家中皮肤美白产品的使用范围特别 广泛。(1, 12) 男性和女性都使用皮肤美白产 品。(13) • 皮肤美白行业是全球增长最快的美容行业之一，预计 到 2024 年将达到 312 亿美元的产值。(14) 例如， 印度国内皮肤美白行业（包括含汞和不含汞的产品） 在护肤市场中所占份额为 50％，估计价值为 4.5 亿 至 5.35 亿美元。(14) • 许多国家和地区均生产含汞的皮肤美白产品，包括孟 加拉国、(15) 中国、(16, 17) 多米尼加共和 国、(18) 香港特别行政区（中国）、(15) 牙买 加、(15) 黎巴嫩、(19) 马来西亚、(15) 墨西 哥、(17, 20) 巴基斯坦、(21) 菲律宾、(22) 大韩民 国、(15) 泰国 (23, 24) 和美国。(25) • 含汞的皮肤美白产品可在网上销售，通过社交媒体网站 在线推广，并通过移动应用程序出售。根据美国食品药 品监督管理局 (FDA) 的规定，这些产品通常在国外制造 并在美国非法销售，常见于面向拉丁裔、亚裔、非洲裔 或中东裔社区的小商店和非正规市场中。消费者也会在 其他国家购买这些产品并将其带回自己国家。(26) 皮肤 美白产品中通常都会非法添加汞，这种有毒产品的贸易 是全球危机，预计只会随着需求激增而恶化，尤其是在 非洲、亚洲和中部地区。(15) • 2011 年由德国联邦环境、自然保护和核安全部资助的 调查指出，巴西、吉尔吉斯斯坦、墨西哥和俄罗斯联 邦的民众认为，很容易获得含汞的皮肤美白产 品。(11) • 清汞行动联盟 (Zero Mercury Group) 在 2017 年和 2018 年进行了一项有关全球皮肤美白霜的研究，从 22 个国家的正规和非正规市场中收集了 338 个皮肤 美白霜样本，鉴定用作活性成分的汞的检出率和浓 度“概况”。研究发现 34 种乳霜（10％ 的样本）的 汞含量很高，即高于 1 ppm。鉴定 22 个国家的样本 后，发现这些汞含量高的样本来自其中 7 个国家。在 这 7 个国家中，4 个国家有禁止汞含量超过 1 ppm 的要求。总体而言，这些特定产品中的汞浓度范围从 93 ppm 到 16,000 ppm 以上。(15) 其他研究发现皮 肤美白产品中的汞浓度甚至更高。(27) • 自 2010 年以来，加利福尼亚州公共卫生部环境卫生 调查科 (EHIB) 已对多个中毒事件进行了调查，其中 涉及遮瑕和祛斑面霜产品中的汞。他们发现了来自柬 埔寨、中国、日本、墨西哥、巴基斯坦和菲律宾的各 种含汞产品。EHIB 判定有些产品造成了严重的健康问 题，包括需要住院治疗的健康问题。(28) • 许多国家颁布了禁止含汞化妆品的法规，但是还有很 多国家尚未颁布。尽管法规禁止含汞产品，但其供应 情况仍然是一个问题。(29) 即使禁止分销，含汞产品 却依然比比皆是。(11) • 不含汞的皮肤美白产品可能会含有其他有害物质，例 如对苯二酚。在使用皮肤美白产品的地方，消费者可 能没有意识到这些产品中化学物质的有害影响。(30) 产品、包装和成分 • 皮肤美白产品有不同的形式，包括乳霜和香皂。香皂 可作为“抗菌香皂”出售。(3) 据说应该将这些产品 用于皮肤，自然晾干并保留过夜。(3) 男性和女性均 使用香皂清洗自己的头发、手臂、脸部或全身。(3) 据报道，有些人已经使用这些产品长达数十年。(1) • 商店内和网上销售的香皂均呈条块状，并且分别以盒 装形式出售。(4) 乳霜一般都封装在软管或广口瓶 中。(4) 香皂大约含有 1–3％ 的碘化汞，乳霜含有 1–10％ 的汞铵。(3) 有些经检测的香皂产品含有的 汞浓度高达 31 mg/kg (31 ppm)，而一些乳霜产品中 含有的汞浓度高达 33,000 mg/kg (33,000 ppm) 。(27)《水俣公约》对皮肤美白产品规定限值为 1 mg/kg (1 ppm)。然而，为了增加美白效果，许多化 妆品中的汞含量均高于 1 mg/kg (1 ppm)。(9, 10) • 产品中汞的含量或浓度可能会在包装上或成分表中标 示。需要注意的名称包括：汞、Hg、碘化汞、氧化汞、 氯化汞、乙基汞、苯基汞盐、氨化汞、氯化汞酰胺、碘 化汞或“有毒物质”。用法说明中要求避免接触银、 金、橡胶、铝和珠宝也可能表明存在汞。(3, 4, 26, 31–33) 最令人担忧的是，销售含汞产品的公司不一定 会在成分表中列出上述物质。 其他含汞的化妆品 • 眼部化妆品中也可能会使用汞，例如用作睫毛膏和眼 部清洁产品中的防腐剂。(1, 3, 31) • 汞以两种形式存在于化妆品中：无机汞和有机 汞。(31, 34, 35) 无机汞可用于皮肤美白霜和香皂 中。有机汞化合物（例如含有乙基汞的硫柳汞和苯基 汞盐）可在睫毛膏等眼部化妆品以及眼部清洁产品中 用作化妆品防腐剂。(3, 31–33) 这些形式的汞的毒 性程度不同，并且对神经、消化和免疫系统以及肺、 肾、皮肤和眼睛会有不同的影响。(36) • 《水俣公约》没有对用作眼部化妆品防腐剂的汞设定 限制，并且目前尚无有效、安全的替代品。(8) 对健康的影响 • 皮肤美白霜和香皂中所含无机汞对健康的不良影响包 括：肾脏损害、(7) 皮疹、皮肤变色和疤痕、皮肤对细 菌和真菌感染的抵抗力下降、(31) 焦虑、抑郁、精神病 和周边神经病变。(3, 31) • 医学文献报告了个别人士通过皮肤美白霜和香皂接触汞后 产生上述健康影响的具体实例。一个病例报告描述了一位 34 岁的中国女性出现肾病综合征，该病的特征是尿蛋白含 量高。肾病综合征可能会导致一系列影响个人健康和生活 质量的并发症。在停止使用皮肤美白霜后，该女性血液和 尿液中的汞含量分别在 1 个月和 9 个月后恢复正 常。(37) 另一个病例报告描述了一位 54 岁的女性在 49 岁时起病，患有痴呆、癫痫和周边多发性神经病。6 年来 她每天都使用皮肤美白霜，停止接触后，血液和尿液中汞 的含量立即恢复到无接触的水平。(38) • 一项研究表明，非洲女性肾病综合征患者中，有很大一部 分人使用含有氨基氯化汞的皮肤美白霜长达一个月至三 年。在停止使用含汞的皮肤美白霜后，尿液中的汞含量迅 速降至无接触的范围内。超过四分之三的女性停止使用美 白霜后症状得到缓解。(7, 39) • 香皂、乳霜和其他化妆品中的汞最终会排放到废水中， 随后进入环境中甲基化并且会变成鱼类中的剧毒甲基汞 进入食物链。(3) 孕妇食用含有甲基汞的鱼类后会将汞 转移给胎儿，从而可能会导致儿童神经发育缺陷。(3) • 通过测量，可以量化血液和尿液中的无机汞。(34) 法规 • 《关于汞的水俣公约》是一项“旨在保护人类健康和 环境免受汞和汞化合物人为排放和释放的危害”的全 球公约。(8) 该《公约》自 2017 年 8 月 16 日起生 效，截至 2019 年 11 月，已有 114 个国家批准《公 约》。在 2020 年之后，《公约》缔约方必须禁止制 造、进口和出口“（含汞量超过 1 ppm 的）化妆品， 2 包括美白香皂和面霜，但不包括以汞为防腐剂并且无有 效、安全替代品的眼部化妆品”，除非该缔约方已登记 豁免至 2025 年。(8, 40) 截至 2019 年 11 月，许多 缔约方均已登记此类豁免。(8, 41) 该《公约》的目的 并非要涵盖含有微量汞污染物的化妆品、香皂或乳 霜。(8) • 欧盟 (42, 43) 和许多其他国家都有禁止含汞化妆品的法 规。这些国家包括加拿大、(44) 菲律宾 (24) 和美国 (45) 以及一些非洲国家 (11)，包括加纳、尼日利亚和乌 干达。(12) 需要采取的措施 • 为了保护公众免受皮肤美白产品中汞对健康产生的负面 影响，需要采取能够促使社会各方面参与的措施，例如 但不限于： 建立或完善法规； 实施法规的合规性和执法策略，包括对报关代理人 进行培训以及识别制造商和供应链； 加强实验室检测皮肤美白产品中含汞的能力； 开展由国家卫生当局举办的宣传活动，以及公众意 识宣传活动，让消费者了解皮肤美白产品（包括含 汞产品）对健康的危害；和 增强医疗专业人员的意识，关注与皮肤美白产品（ 包括含汞产品）相关的健康风险，告知并教育患者 和社区。 结论 • 含汞的皮肤美白产品对健康有害，因此在许多国家中都禁 止使用。即使在一些已禁止使用此类产品的国家中，仍然 可以通过网络和其他方式向消费者进行广告宣传并提供产 品。 • 鉴于全球含汞化妆品的使用量正在不断增长，因此非常 需要增强公众意识。 • 通常必须向消费者提供有关皮肤美白产品危害的信息， 因为即使不含汞的皮肤美白产品也可能会含有其他有害 物质，例如对苯二酚。 如需进一步了解世界卫生组织针对汞发布的信息，请访问： https://www.who.int/health-topics/chemical-safety 3 参考文献 1. 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Sacramento, California Department of Public Health.Environmental Health Investigations Branch (https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/ EHIB/CPE/CDPH%20Document%20Library/Word%20 Creams%20Doc_FINAL_ADA.pdf). 29. Bell L, DiGangi J, Weinberg J (2014).An NGO introduction to mercury pollution and the Minamata Convention on Mercury.Gothenburg, International POPs Elimination Network (https://ipen.org/sites/default/files/ documents/ipen-booklet-hg-update-v1_6-en-2-web. pdf). 30. Jose A, Ray JG (2018).Toxic content of certain commercially available fairness creams in Indian market.Cogent Med, 5(1):1433104. 31. Ladizinski B, Mistry N, Kundu RV (2011). Widespread use of toxic skin lightening compounds: medical and psychosocial aspects. Dermatol Clin, 29(1):111–123. 32. Al-Saleh I, Al-Doush I (1997).Mercury content in skin-lightening creams and potential hazards to the health of Saudi women.J Toxicol Environ Health, 51(2):123–130. 33. UNEP (2019).Lists of mercury compounds and mercury-added products.UNEP/MC/COP.3/INF/18.In: Information Documents from the Third Meeting of the Conference of the Parties to the Minamata Convention on Mercury (COP3).Nairobi, United Nations Environment Programme (document available for download from: http://www. mercuryconvention.org/Meetings/COP3). 34. ATSDR (1999).Toxicological profile for mercury. Atlanta, Agency for Toxic Substances & Disease Registry (http://www.atsdr.cdc.gov/toxprofiles/ TP.asp?id=115&tid=24). 35. WHO (2007).Exposure to mercury: a major public health concern.Geneva, World Health Organization (Preventing disease through healthy environments series; http://www.who.int/phe/news/Mercury-flyer.pdf). 36. WHO (2017).Mercury and health.Key facts.Geneva, World Health Organization (https://who.int/ news-room/fact-sheets/detail/mercury-and- health). 37. Tang HL, Chu KH, Mak YF, Lee W, Cheuk A, Yim KF, et al.(2006).Minimal change disease following exposure to mercury-containing skin lightening cream.Hong Kong Med J, 12(4):316– 318. 38. Zellner T, Zellner N, Felgenhauer N, Eyer F (2016).Dementia, epilepsy, and polyneuropathy in a mercury-exposed patient: investigation, identification of an obscure source of treatment.BMJ Case Rep, 2016:bcr2016216835. 39. Barr RD, Rees PH, Cordy PE, Kungu A, Woodger BA, Cameron HM (1972).Nephrotic syndrome in adult Africans in Nairobi.Br Med J, 2(5806):131–134. 40. BRI (2018).Phasing out mercury-added products: skin lightening products and other cosmetics. Portland, Biodiversity Research Institute (http://www.briloon.org/uploads/BRI_Documents/ Mercury_Center/UNEP%20Projects/2019/FOR%20 WEB%20Global%20Cosmetics%20Flyer%20revised%20 2019.pdf). 41. UNEP (2019).Exemptions Under the Minamata Convention on Mercury.Nairobi, United Nations Environment Programme. (http://www.mercuryconvention.org/Countries/ Parties/Exemptions/tabid/5967/language/en-US/ Default.aspx). 42. IPCS (1991).Mercury-containing cream and soap. In: Inorganic mercury.Geneva, World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 118; (http://www.inchem.org/documents/ehc/ehc/ ehc118.htm#SectionNumber:3.5). 43. European Commission (2019).Annex V. List of preservatives allowed in cosmetic products.In: Regulation (EC) No. 1223/2009 of the European Parliament and of the Council.Updated July 11, 2019.Brussels, The European Commission (http://ec.europa.eu/growth/tools-databases/ cosing/pdf/COSING_Annex%20V_v2.pdf). 44. Health Canada (2012).Guidance on heavy metal impurities in cosmetics.Ottawa, Health Canada (http://www.hc-sc.gc.ca/cps-spc/pubs/indust/ heavy_metals-metaux_lourds/index-eng.php). 45. U.S. FDA (2019).CFR – Code of Federal Regulations Title 21.Chapter I: Food and Drug Administration.Subchapter G: Cosmetics.Silver Spring, United States Department Food and Drug Administration (http://www.accessdata.fda.gov/ scripts/cdrh/cfdocs/cfCFR/CFRSearch. cfm?fr=700.13&SearchTerm=mercury). 6 7 WHO/CED/PHE/EPE/19.13 © 世界卫生组织 2019 年 保留部分版权。本作品可在知识共享署名——非商业性使用——相同方式共享 3.0 政府间组织 (CC BY-NC- SA 3.0 IGO) 许可协议下使用。 世界卫生组织已采取一切合理的预防措施来核实本出版物中包含的信息。但是，已出版材料的分发无任何明 确或隐含保证。解释和使用材料的责任取决于读者。世界卫生组织对于因使用这些材料而造成的损失不承担 任何责任。 2011 年发布了具有相同标题的信息表，这是更新版，德国联邦环境、自然保护和核安全部对此给予了资助。 公共卫生及健康问题环境和社会决定因素司 世界卫生组织 20 Avenue Appia, 1211 Geneva 27, Switzerland
الزئبق في منتجات تفتيح البشرة الوقاية من الأمراض من خلال توفير البيئات الصحية الزئبق مكون شائع الاستخدام في كريم وصابون تفتيح البشرة على الرغم من خطورته. تعزز معايير الجمال التي تروج لها وسائل الإعلام والإعلانات وحملات التسويق من انتشار المفهوم الخاطئ بأن أصحاب البشرة الفاتحة مرغوبين بدرجة أكبر من أصحاب البشرة السمراء. يشيع استخدام كريم وصابون تفتيح البشرة في عدد كبير من البلدان الأفريقية والآسيوية وبلدان البحر الكاريبي. (1 و2) كما تستخدمها أيًضا الفئات ذات البشرة السمراء في أوروبا وأمريكا الشمالية.(3–5) تمنع أملاح الزئبق تُكون صبغة الميلانين وهو الأمر الذي يجعل درجة لون البشرة أكثر بياًضا.(6 و7) تضع اتفاقية ميناماتا بشأن الزئبق حًدا أقصى قدره واحد ملغ/كغم (جزء واحد في المليون) لمنتجات تفتيح البشرة،(8) ومع ذلك، هناك العديد من منتجات التجميل المحتوية على مستويات من الزئبق أعلى من هذا القدر المحدد بغرض زيادة القدرة على تفتيح البشرة.(9 و01) وعلى الرغم من حظر تداول منتجات تفتيح البشرة المحتوية على الزئبق في عدد كبير من البلدان، فإنه يسهل الحصول عليها في أغلب الأحيان.(11) يمكن استبعاد الزئبق في منتجات تفتيح البشرة عن طريق التعاون مع وزارات الصحة والبيئة ورفع مستوى الوعي العام بأخطار الزئبق على الصحة وأخطار المواد الكيميائية الأخرى الموجودة في منتجات تفتيح البشرة. هناك حاجة إلى اتخاذ الحكومات إجراءات تنظيمية لإيقاف تصنيع واستيراد وتصدير منتجات تفتيح البشرة بما يتفق مع اتفاقية ميناماتا - بما فيها تدريب وكلاء التخليص الجمركي - ويجب عليها كذلك القيام بحملات إعلامية كبيرة لمساندة هذا التوجه. الاستخدام والإنتاج والتوفر يتم استخدام منتجات تفتيح البشرة في جميع أنحاء العالم، ولكن يتزايد استخدامها بصفة خاصة في العديد من البلدان الأفريقية والآسيوية وبلدان البحر الكاريبي.(1 و21) ويستخدم الرجال والنساء منتجات تفتيح البشرة على حد سواء.(31) تُعد صناعة منتجات تفتيح البشرة واحدة من أسرع مجالات منتجات الجمال نمًوا في أنحاء العالم وتُقدر قيمتها بمبلغ 2.13 مليار دولار أمريكي بحلول عام 4202.(41) في الهند، على سبيل المثال، تمثل صناعة منتجات تفتيح البشرة (بما فيها المنتجات التي تحتوي على الزئبق أو الخالية منه) حوالي 05% من سوق منتجات العناية بالبشرة وتقدر قيمتها بمبلغ يتراوح من 054 إلى 535 مليون دولار.(41) تُصنع منتجات تفتيح البشرة المحتوية على الزئبق في العديد من البلدان والمناطق وتشمل بنغلاديش,(51) والصين,(61 و71) والجمهورية الدومينيكية،(81) ومنطقة هونغ كونغ الإدارية الخاصة (الصين)،(51) وجامايكا،(51) ولبنان،(91) وماليزيا،(51) والمكسيك،(71 و02) وباكستان،(12) والفلبين،(22) وجمهورية كوريا،(51) وتايلند(32 و42)، والولايات المتحدة الأمريكية.(52) تتوفر منتجات تفتيح البشرة المحتوية على الزئبق للبيع عبر الإنترنت كما يتم الترويج لها في مواقع التواصل الاجتماعي وبيعها من خلال تطبيقات الهواتف المحمولة. وفقًا لإدارة الأغذية والعقاقير في الولايات المتحدة، غالبًا ما يتم تصنيع هذه المنتجات في الخارج وبيعها داخل الولايات المتحدة بطرق غير مشروعة في المتاجر الصغيرة والأسواق غير الرسمية في معظم الأحيان للمجتمعات المنحدرة من أصول لاتينية أو آسيوية أو أفريقية أو شرق أوسطية. يشتري المستهلكون هذه المنتجات أيًضا من بلدان أخرى ويجلبونها معهم عند العودة إلى بلادهم.(62) إن تجارة السّميات لمنتجات تفتيح البشرة المضاف إليها الزئبق، والتي غالبًا ما تكون غير مشروعة، تعتبر أزمة عالمية ومن المتوقع أن تسوء الأمور بدرجة أكبر بسبب ارتفاع الطلب عليها بصورة هائلة، وبخاصة في أفريقيا وآسيا والشرق الأوسط.(51) أشار مسح تم في عام 1102 والذي مولته الوزارة الاتحادية الألمانية للبيئة وحفظ الطبيعة والسلامة النووية، إلى وجود أشخاص من البرازيل وقرغيزستان والمكسيك والاتحاد الروسي يعتقدون أنه من السهل الحصول على منتجات تفتيح البشرة المحتوية على الزئبق.(11) منظمة الصحة العالمية قامت دراسة أجرتها "المجموعة المعنية بالقضاء التام على الزئبق" في عامي 7102 و8102 بجمع 833 عينة من كريم تفتيح البشرة من 22 بلًدا من كٍل من الأسواق الرسمية وغير الرسمية بهدف الحصول على "لمحة موجزة" عن معدل تكرار وتركيزات استخدام الزئبق كمكون فعال في كريمات تفتيح البشرة حول العالم. ُوجد أن أربعة وثلاثين كريًما (01% من العينات) تحتوي على مستويات مرتفعة من الزئبق أي أنه يزيد عن جزء واحد في المليون. تم العثور على هذه العينات ذات المستوى المرتفع من الزئبق في سبعة بلاد من 22 بلًدا. من هذه البلدان السبعة، توجد أربعة بلدان تضع اشتراطات تمنع وجود محتوى من الزئبق يزيد عن جزء واحد في المليون. وبشكل عام، تتراوح تركيزات الزئبق في هذه المنتجات المشار إليها ما بين 39 جزًءا في المليون وأكثر من 00061 جزء في المليون.(51) وكشفت دراسات أخرى عن وجود تركيزات أعلى من الزئبق في منتجات تفتيح البشرة.(72) منذ عام 0102، أجرى فرع تحقيقات الصحة البيئية (BIHE) التابع لإدارة كاليفورنيا للصحة العمومية تحقيقات في حالات تسمم تشمل الزئبق في منتجات وكريم للوجه خاصة بإزالة العيوب والحبوب. وقد وجدوا منتجات متنوعة تحتوي على الزئبق واردة من كمبوديا والصين واليابان والمكسيك وباكستان والفلبين. قرر فرع تحقيقات الصحة البيئية أن بعض المنتجات قد تسبب في مشاكل صحية خطيرة بما فيها مشاكل تتطلب الدخول إلى المستشفى والمكوث بها.(82) سنت العديد من البلدان تشريعات تحظر منتجات التجميل المحتوية على الزئبق، ولكن ما زال هناك عدد كبير لم يتخذ هذه الخطوة بعد. وعلى الرغم من سريان تشريعات تحظر المنتجات المحتوية على الزئبق، يمثل توفر هذه المنتجات مشكلة قائمة حتى الآن.(92) وحتى في الأماكن المحظور فيها توزيع المنتجات، يظل الحصول على المنتجات المحتوية على الزئبق أمًرا في غاية السهولة في أغلب الأحيان.(11) قد تحتوي منتجات تفتيح البشرة غير المحتوية على الزئبق، على مواد خطرة أخرى مثل هيدروكينون. في الأماكن التي يتم استخدام منتجات تفتيح البشرة، ربما يكون المستهلكون غير مدركين للتأثيرات الضارة للمواد الكيميائية الموجودة في هذه المنتجات.(03) المنتجات ومواد التغليف والمكونات تأتي منتجات تفتيح البشرة في أشكال مختلفة، تشمل الكريم والصابون. يمكن بيع الصابون تحت مسمى "صابون مطهر".(3) ومن المفترض أن يتم استخدام هذه المنتجات على البشرة حتى تجف طوال الليل.(3) يستخدم الرجال والنساء على حد سواء الصابون لغسل شعرهم أو أيديهم أو وجوههم أو أجسامهم بالكامل.(3) وقد وردت تقارير تفيد بأن بعض الأشخاص قد استخدموا هذه المنتجات طوال عقود من الزمن.(1) يأتي الصابون الذي يتم بيعه في المتاجر وعبر الإنترنت على شكل قوالب تباع فرادى أو في عبوات.(4) يتم وضع الكريم عامة ًفي أنابيب أو برطمانات.(4) يحتوي الصابون على حوالي 1 إلى 3% من يوديد الزئبق ويتكون الكريم من 1 إلى 01% ألمونيوم الزئبق.(3) احتوت بعض منتجات الصابون التي تم اختبارها على زئبق بتركيزات تصل إلى 13 ملغ/كغم (13 جزء في المليون)، بينما وجد أن بعض منتجات الكريم تحتوي على تركيزات مرتفعة من الزئبق تصل إلى 00033 ملغ/كغم (00033 جزء في المليون).(72) تضع اتفاقية ميناماتا حًدا أقصى قدره 1 ملغ/كغم (جزء واحد في المليون) في منتجات تفتيح البشرة، ومع ذلك، هناك العديد من منتجات التجميل المحتوية على مستويات من الزئبق أعلى من 1 ملغ/كغم (جزء واحد في المليون) بغرض زيادة القدرة على تفتيح البشرة.(9 و 01) يمكن كتابة كمية أو تركيز الزئبق الموجودة في منتج على العبوة أو في قائمة المكونات. تشمل الأسماء التي يجب البحث عنها: الزئبق أو gH أو اليوديد الزئبقي أو أكسيد الزئبق أو كلوريد الزئبق أو إيثيل الزئبق أو أملاح فنيل الزئبق أو الزئبق النشادري أو كلوريد أميد الزئبق أو يوديد الزئبق أو كلمة "سم". قد تشير أيًضا إرشادات الاستخدام التي تنصح بتجنب ملامسة الفضة والذهب والمطاط والألومنيوم والمجوهرات إلى وجود الزئبق.(3 و4 و62 و13 إلى 33) ومن الأمور التي تثير المخاوف بدرجة كبيرة هو عدم إدراج الشركات التي تبيع المنتجات المحتوية على الزئبق لاسمه في قائمة المكونات. مستحضرات التجميل الأخرى المحتوية على الزئبق يمكن العثور أيًضا على الزئبق في منتجات التجميل الخاصة بالمنطقة المحيطة بالعين، مثل الماسكرا، وفي منتجات تنظيف العينين من مستحضرات التجميل حيث يتم استخدامها كمادة حافظة.(1 و3 و13) يوجد الزئبق في مستحضرات التجميل بشكلين: عضوي وغير عضوي. (13 و43 و53) يُستخدم الزئبق غير العضوي في كريمات وصابون تفتيح البشرة. تُستخدم مركبات الزئبق العضوي (مثل الثيوميرسال الذي يحتوي على إيثيل الزئبق وأملاح فينيل الزئبق) كمواد حافظة تجميلية في المستحضرات الخاصة بالعين بما فيها الماسكرا، ومنتجات تنظيف العين من مستحضرات التجميل.(3 و13 إلى 33) تختلف هذه الأشكال من الزئبق في درجة سميّتها ولها تأثيرات متباينة على الجهاز العصبي والهضمي والمناعي بالإضافة إلى الرئتين والكليتين والبشرة والعينين.(63) لا تضع اتفاقية ميناماتا حًدا على منتجات التجميل الخاصة بالمنطقة المحيطة بالعين حيث يُستخدم الزئبق كمادة حافظة ولا يوجد لها بديل فعّال ومأمون.(8) 2 التأثيرات على الصحة تشمل التأثيرات العكسية على الصحة التي يسببها الزئبق غير العضوي الموجود في كريمات وصابون تفتيح البشرة: تضرر الكليتين،(7) الطفح الجلدي، وتغير لون البشرة، وحدوث الندوب وضعف مقاومة البشرة للعدوى البكتيرية والفطرية،(13) والشعور بالقلق، والاكتئاب، والاضطرابات النفسية، واعتلال الأعصاب الطرفية.(3 و13) وقد أشارت المراجع الطبية إلى وجود حالات معينة لأفراد يعانون من التأثيرات على الصحة المذكورة أعلاه والتي تحدث بعد التعرض للزئبق من خلال كريمات وصابون تفتيح البشرة. يصف أحد هذه التقارير حالة سيدة صينية عمرها 43 عاًما أصيبت بمتلازمة كلوية، وهي حالة تتسم بارتفاع مستويات البروتين في البول. يمكن أن تقترن المتلازمة الكلوية بسلسلة من المضاعفات التي تؤثر على صحة الفرد وجودة حياته. عادت مستويات الزئبق في دم وبول السيدة إلى معدلاتها الطبيعية بعد مرور شهر وتسعة شهور على الترتيب، بعد أن توقفت عن استخدام كريم تفتيح البشرة.(73) يصف تقرير حالة أخرى سيدة تبلغ من العمر 45 عاًما وقد بدأ ظهور أعراض الخرف عليها، والصرع واعتلال الأعصاب الطرفية المتعدد (94). وبعد ستة أعوام من الاستخدام اليومي لكريم تفتيح البشرة، تم إيقاف التعرض للزئبق على الفور، وعادت بعدها مستويات الزئبق في الدم والبول إلى مستويات ما قبل التعرض للزئبق.(83) كشفت إحدى الدراسات نسبة كبيرة من المتلازمة الكلوية بين النساء الأفريقيات اللاتي يستخدمن كريمات تفتيح البشرة المحتوي على كلوريد الزئبق الأموني لفترات تتراوح من شهر واحد إلى ثلاثة أعوام. بعد إيقاف استخدام كريمات تفتيح البشرة المحتوي على الزئبق، تنخفض مستويات الزئبق في البول بسرعة لتصل إلى نطاق ما قبل التعرض للزئبق. دخل أكثر من ثلاثة أرباع النساء اللاتي توقفن عن استخدام الكريمات في مرحلة هدوء بعد اختفاء الأعراض.(7 و93) الزئبق الموجود في الصابون والكريمات ومنتجات التجميل الأخرى يتم التخلص منه بالفعل في مياه الصرف. يدخل الزئبق بعد ذلك إلى البيئة، حيث يتحول إلى ميثيل الزئبق ويمكن أن يدخل إلى سلسلة الغذاء ويتسبب في ارتفاع مستوى سمية ميثيل الزئبق في الأسماك.(3) يمكن أن تنقل النساء الحوامل ميثيل الزئبق الموجود في الأسماك إلى الأجنة، مما قد يؤدي إلى حدوث عيوب خلقية عصبية في الأطفال.(3) يمكن تحديد حجم التعرض للزئبق غير العضوي عن طريق قياسات يتم إجراؤها على الدم والبول.(43) اللوائح اتفاقية ميناماتا بشأن الزئبق هي معاهدة عالمية تهدف إلى "حماية صحة الإنسان والبيئة من الانبعاثات والإطلاقات البشرية المنشأ للزئبق ومركباته."(8) وقد أصبحت الاتفاقية سارية المفعول بدًءا من 61 أغسطس/ آب 7102، وبحلول شهر نوفمبر/تشرين ثان 9102 بلغ عدد البلاد التي وقعت على الاتفاقية 411 بلًدا. بعد عام 0202، ستكون أطراف الاتفاقية مطالبة بحظر تصنيع واستيراد وتصدير "مواد التجميل (ويزيد ما تحتوي عليه من الزئبق عن جزء واحد في المليون) بما في ذلك صابون وكريمات تفتيح البشرة، ويستثنى منها مواد تجميل المنطقة المحيطة بالعين حيث يُستخدم الزئبق كمادة حافظة ولا يوجد لها بديل فعّال ومضمون" وذلك باستثناء الطرف الذي سجل إعفائه من هذا الأمر حتى عام 5202.(8 و04) وبحلول شهر نوفمبر/تشرين ثان 9102، كان عدد من الأطراف قد سجل بالفعل هذا الإعفاء.(8 و14) الغرض من الاتفاقية هو عدم تغطية مستحضرات التجميل أو الصابون أو الكريم الذي يحتوي على آثار للتلوث بالزئبق.(8) يملك الاتحاد الأوروبي(24 و 34) والعديد من البلدان الأخرى لوائح تحظر منتجات التجميل المحتوية على الزئبق. تشمل هذه البلدان كندا، (44) والفلبين (42)، والولايات المتحدة الأمريكية،(54) وكذلك عددا ًمن البلاد الأفريقية،(11) وتشمل غانا ونيجيريا وأوغندا.(21) الإجراءات المطلوبة هناك حاجة من جانب أطراف عديدة من المجتمع لاتخاذ إجراءات من أجل حماية صحة العامة من التأثيرات السلبية للزئبق الموجود في منتجات تفتيح البشرة، وتشمل هذه الإجراءات ولا تقتصر على: وضع التشريعات أو تحسينها؛ وتطبيق استراتيجيات الامتثال للتشريعات وإنفاذها، بما في ذلك تدريب وكلاء التخليص الجمركي وتحديد هوية المصنّعين وسلاسل التوريد؛ ورفع قدرات المختبرات بدرجة كافية لاختبار وجود الزئبق في منتجات تفتيح البشرة؛ وإجراء حملات مناصرة لهذه القضية من قِبل السلطات الوطنية المعنية بالصحة، بالإضافة لحملات الوعي العام لتعريف المستهلكين بالمخاطر الصحية التي تنطوي على استخدام منتجات تفتيح البشرة بما في ذلك تلك المنتجات المحتوية على الزئبق؛ ورفع مستوى الوعي بين العاملين المتخصصين في مجال الصحة بشأن المخاطر الصحية المقترنة باستخدام منتجات تفتيح البشرة بما في ذلك تلك المنتجات المحتوية على الزئبق بغرض تعريف وتثقيف المرضى والمجتمع بأكمله. 3 الخلاصة تمثل منتجات تفتيح البشرة المحتوية على الزئبق خطًرا على الصحة ولذلك تم حظرها في عدد كبير من البلدان. ومع ذلك، يستمر الإعلان عن هذه المنتجات وتوفيرها للمستهلكين من خلال الإنترنت وسبل أخرى حتى في بعض البلاد التي تم فيها تنفيذ قرارات الحظر. هناك حاجة كبيرة لنشر الوعي العام في ما يتعلق بزيادة استخدام منتجات التجميل المحتوية على الزئبق في أنحاء العالم. يجب توفير معلومات عامة عن الأخطار المقترنة باستخدام منتجات تفتيح البشرة للمستهلكين، فحتى منتجات تفتيح البشرة غير المحتوية على الزئبق، قد تحتوي على مواد خطرة أخرى مثل هيدروكينون. للاطلاع على معلومات أكثر عن الزئبق صادرة من منظمة الصحة العالمية، يرجى زيارة: ytefas-lacimehc/scipot-htlaeh/tni.ohw.www//:sptth 4 5عجارملا 1. 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In: Regulation (EC) No. 1223/2009 of the European Parliament and of the Council. Updated July 11, 2019. Brussels, The European Commission (http://ec.europa.eu/growth/tools-databases/cosing/ pdf/COSING_Annex%20V_v2.pdf). 44. Health Canada (2012). Guidance on heavy metal impurities in cosmetics. Ottawa, Health Canada (http://www.hc-sc.gc.ca/cps-spc/pubs/indust/heavy_ metals-metaux_lourds/index-eng.php). 45. U.S. FDA (2019). CFR – Code of Federal Regulations Title 21. Chapter I: Food and Drug Administration. Subchapter G: Cosmetics. Silver Spring, United States Department Food and Drug Administration (http://www.accessdata. fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch. cfm?fr=700.13&SearchTerm=mercury). 31.91/EPE/EHP/DEC/OHW © منظمة الصحة العالمية 9102 بعض الحقوق محفوظة. يتوفر هذا العمل بموجب ترخيص AS-CN-YB CC 0.3 OGI. لقد اتخذت منظمة الصحة العالمية )OHW( كافة الاحتياطات المعقولة للتحقق من المعلومات الواردة في هذه المطبوعة. ومع ذلك فإن المواد المنشورة تُوزع دون أي ضمان من أي نوع، سواء كان ذلك بشكل صريح أو ضمني. وتقع مسؤولية تفسير المواد واستخدامها على عاتق القارئ. ولن تكون منظمة الصحة العالمية )OHW( مسؤولة بأي حال من الأحوال عن الضرر الناتج عن استخدام تلك المواد. هذه المادة عبارة عن تحديث لورقة المعلومات التي تحمل الاسم نفسه والمنشورة عام 1102، بدعم مالي من الوزارة الاتحادية الألمانية للبيئة وحفظ الطبيعة والسلامة النووية. إدارة الصحة العمومية، المحددات البيئية والاجتماعية للصحة منظمة الصحة العالمية 02 dnalreztiwS ,72 aveneG 1121 ,aippA eunevA