The obsession for blemish-free and even-toned skin is a common phenomenon with many women of diverse ethnic backgrounds and cultures.

In fact, the global market for skin whitening alone in 2022 was estimated at $8 billion, with a projected increase of nearly an additional 50% within six years.

As we know, pigmentation and melasma are one of the most challenging conditions to treat.  Skincare professionals are trained to take a personalised and clinical approach with each individual client and investigate the origin and cause of the pigmentation or melasma to determine and recommend an effective treatment plan. 

Meanwhile, as the global demand for skin whitening products continues to grow, unscrupulous skincare formulators are resorting to high levels of toxic ingredients in a bid to capture this growing market segment. Here we uncover some of the high risks factors that are impacting not just the user, but possibly their whole family.

In the US, a woman lost part of her vision and inadvertently put her entire household at risk of mercury poisoning, through the use of a skincare cream containing high levels of the toxic chemical, according to a case report shared exclusively with CNN.

The report, shared by Dr Erin Batdorff with the Minnesota Poison Control System, details the extensive symptoms experienced by the woman and her family, and how home visits conducted by the Minnesota Pollution Control Agency (MPCA) found high levels of mercury in both her and her children’s bedrooms, bedding, household towels and laundry area.

Batdorff, a fellow in medical toxicology who examined the woman in her home told CNN. “No one intentionally wants to hurt themselves or their family members. But it’s out there and you can’t see it, you can’t smell it. There’s no way for consumers to know whether mercury is in the creams or not because it’s not noted on the labels.”

The woman, whose name has been concealed in the report to protect her identity, was referred to Batdorff’s team after she reported an array of symptoms to multiple doctors, ranging from insomnia and leg pain to muscle weakness, fatigue and, eventually, the loss of her peripheral vision.

Clinical tests revealed elevated levels of mercury in her blood and urine.

Batdorff explained that the most common symptom she sees from potential mercury poisoning is tingling or numbness in a patient’s hands or feet. She described the woman’s loss of vision as “a more extreme and permanent symptom.”

“Unfortunately, she will not recover her vision,” Batdorff told CNN. “So being a young woman that now has vision loss is really frightening and pretty concerning.”

The toxicologist added that there are likely to be many more people who are being exposed to toxic levels of mercury and are not showing symptoms, or at least not yet.

Following the referral, Batdorff and the MPCA visited the woman’s house twice, about a year apart.

On the first visit, she presented to Dr Batdorff and his team the skin whitening creams that she had purchased from abroad but said she was no longer using them.

The team found the amount of mercury in two of those products to be several thousand times higher than the permitted levels of 1 part per million (ppm) in cosmetics and urine tests revealed high levels of mercury in her body (23mcg/litre), but mercury was not noted as an ingredient listed in the products.

At that time, the team did not consider the levels of mercury in her home to be a concern, but over the course of a year, the mother had increasingly elevated levels of mercury in her body, the case report states.

A second home visit in 2022 found that two new skincare products the woman had bought at a local department store, one of which was not labelled as skin whitening but was known to be used for this purpose, also contained high levels of mercury.

The products found in her home were empty from use, but the MPCA team tested new unopened versions of the same product, finding extremely high levels of mercury of 11,000 and 18,000 ppm.

There are limited outlets for the availability of these products, and we have no reason or evidence to believe there would be any difference in the products,” said John Gilkeson, Toxics Reduction Specialist at the MPCA, who tested the woman’s home and has conducted three visits to the homes of people using skin whitening creams in recent years.

New urine tests confirmed that the mercury level in her body had risen to 46.6 micrograms/litre – more than nine times the level considered normal (5 micrograms/litre) – and certain areas in her home now also contained elevated levels of mercury, putting her family at risk.

Background mercury levels below 200 nanograms per cubic metre (ng/m3) are not considered a concern, Gilkeson explained. But the children’s bedrooms recorded levels of up to 400 ng/m3 and their towels read up to 600 mg/m3, according to the case report.

Levels of up to 300 mg/m3 were found in the washing machine, where mercury likely accumulated as clothes worn by the mother were laundered, in turn contaminating other clothing and materials that go into the machine. Urine tests on one of her children found that they now had elevated levels of mercury in their body, albeit much lower than their mother at 6.88 micrograms/litre.

The number one possible source of mercury exposure

Mercury has long been used in skin whitening products due to its ability to block the production of melanin. US Federal Drug Agency regulations and the Minamata Convention on Mercury – an international treaty to protect human health and the environment from mercury – limit the use of mercury in cosmetics, excluding those used around the eye area, to 1mg/kg of mercury, also known as 1 part per million (ppm).

The products found in the woman’s home ranged from 4590ppm to 18,000ppm. At high levels, the inorganic mercury typically found in these products is extremely toxic. Chronic exposure can lead to kidney and liver damage, as well as neurological damage including personality changes, anxiety, depression, early childhood development issues and, as seemingly shown in this case, vision loss.

With inorganic mercury, it’s that chronic long-term exposure that concerns me the most,” said Batdorff. “It’s more subtle but ends up building up in our system and is hard to eliminate, especially when it gets into the brain … and once mercury has crossed over into the brain and our nervous system, it can cause a lot of unpleasant side effects.”

For Batdorff and other experts, finding people early and removing the sources of mercury before they cause permanent damage is crucial.

Other concerns with skin whitening products

“When we’re thinking about the risks, another area is pregnant women, women of childbearing age and babies and children. We don’t want people in those groups to be exposed to high mercury,” said Jessica Nelson, Program Director for the Minnesota Biomonitoring program within MDH, who led the 2015 and 2019 studies.

“We need to be sure women know that products can have mercury in them. And we also need to focus on women who speak languages other than English and different ways of sharing the information, ideally through community partners.”

Symptoms associated with mercury poisoning may include:

  • Loss of peripheral vision
  • “Pins and needles” feelings, usually in the hands, feet, and around the mouth
  • Lack of coordination of movements 
  • Impairment of speech, hearing, walking and/or
  • Muscle weakness

Skin-whitening uptake sparks concern among Australian dermatologists

According to the Australian Bureau of Statistics’ latest census data from 2011, 24.6 per cent of the population was born overseas, while 43.1 per cent of people have at least one overseas-born parent.

“I think this sort of population shift has actually resulted in an uptake in the potential purchase of skin-whitening agents and certainly in my practice as a dermatologist that specialises in pigmented skin and coloured skin, I’ve seen a growing number of consultations and queries,” Dr Michelle Rodrigues from the College of Dermatologists and a consultant dermatologist in Melbourne said.

“The majority of patients that see me about lightening have a preconceived idea that this is more beautiful and this stems from very deep-seated cultural and historical beliefs that perhaps this leads to increased employment or marital opportunities.”

While there are no national figures for pharmacies and beauty stores the ABC spokesperson confirmed, that the sales of whitening and brightening creams, scrubs, lotions and even pills were increasing.

A Priceline spokesperson also stated that the whole mask trend in skincare is across all categories but particularly in whitening — that’s the fastest-growing trend and you can see that coming out of Korea and China. It’s definitely on-trend, and it’s definitely something that we’ve had to focus on.

Online product purchases

As we know the availability of online skincare is robust, encouraging “do-it-yourself” solutions also for problematic skin conditions. This market can bypass any regulations and exposes consumers to potentially risky products. 

If you are currently treating pigmentation and melasma skin conditions, it is advisable that you warn your clients to ensure they are guided by a qualified practitioner when purchasing their skincare products.