News Excerpt:

Researchers from Kerala have reported a series of cases from Malappuram district where the regular use of fairness creams has been linked to nephrotic syndrome.

• Heavy metal screening of blood and urine samples from these patients revealed high levels of mercury.

More about News: 

• An analysis of the fairness creams used by these patients also showed that some creams contained very high levels of mercury. 
• In some cases 10,000 times above the permissible limit of 1 ppm.
• The study published in Kidney International journal describes 15 such cases of membranous nephropathy (a type of nephrotic syndrome) traced to the use of these mercury-containing fairness creams.

About High proteinuria: 

• A nephrologist in Kozhikode, noticed a specific pattern in cases of membranous nephropathy (MN) diagnosed among his patients since 2021.
• These patients had non-specific symptoms like fatigue, mild edema, and frothy urine but exhibited high levels of proteinuria, ranging from 6.5 to 22.2 g/day.
• Membranous nephropathy (MN) is an autoimmune disease resulting in nephrotic syndrome, a condition where excessive protein is released into the urine (proteinuria), ultimately leading to renal failure.
• Approximately 70% to 80% of membranous nephropathy (MN) cases are caused by the target antigen phospholipase A-2 (PLA2R), but in the cases observed by Doctor most were PLA2R negative.
• Another antigen, Neural epidermal growth factor-like protein 1 (NELL-1), has been linked to a rare form of MN, and a lab in Chennai identified these patients as NELL-1 positive.
• In Tamil Nadu, most NELL-1-related MN cases have been traced to the use of traditional medicines containing high levels of mercury.
• The link between face creams containing mercury and nephrotic syndrome is well-established worldwide,which naturally led us to probe the use of cosmetics.

How Fairness cream affect

• The patients admitted to fairly regular usage of fairness creams before they began experiencing non-specific or subtle symptoms. 
• The research team found 15 cases of Membranous Nephropathy (MN) linked to NELL-1, which is a type of kidney disease.
• In 13 out of the 15 cases, patients had a history of using fairness creams, many of which were unregulated brands promising rapid results and sold locally or online.
• Recognizing the actual cause of nephrotic syndrome (a kidney disorder) by focusing on the patient's clinical history was crucial in limiting further kidney damage.
• After patients stopped using the fairness creams, their mercury levels in blood/urine dropped within three months.
• All patients responded well to RAAS (renin-angiotensin-aldosterone system) blockade (the gold standard therapy for chronic kidney disease) and did not need immunosuppression.
• The obsession with fair skin and the use of skin-lightening products is prevalent beyond India, in African and Asian countries.
• Despite widespread use, the serious systemic health issues caused by toxic cosmetic creams are not yet perceived as a global public health issue.

Impact of Mercury:

• The use of inorganic mercury salts in fairness creams can inhibit melanin formation, resulting in a lighter skin tone. 
• However, this effect is perceived as the product's effectiveness by consumers, leading to brand loyalty.
• Chronic mercury poisoning from cosmetics is often missed because different organs and tissues respond differently to mercury, resulting in atypical clinical presentations.
• Physicians need to be more aware of the possibility of mercury poisoning when patients present with non-specific symptoms like pain, fatigue, cognitive decline, or conditions like membranous nephropathy.
• The concept of equating beauty with fair skin is deeply ingrained, making it challenging for people to stop using fairness creams, even after being cautioned about the risks.
• The larger public is unaware that mercury in face creams can be absorbed through-
• The sweat glands, 
• Sebaceous glands, 
• Hair follicles 
• All tissues.
• Repeated topical use results in systemic toxicity, manifesting as damage to the kidneys and nervous system.
• The other adverse effects listed by WHO include:
• Skin discolouration and 
• Scarring, reduction in the skin’s resistance to bacterial and 
• Fungal infections, 
• Anxiety, depression, psychosis and 
• Peripheral neuropathy. 

• The Minamata Convention on Mercury, to which India is a signatory, is a global treaty “to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds” and it has been in force since 2017.
  • According to a new Zero Mercury Working Group (ZMWG) report released in October 2023, despite being banned by a global treaty, 
  • Mercury-containing skin lightening products are still sold by some of the world’s biggest online retailers to unsuspecting consumers. 
  • It said that of the 213 fairness products from 12 countries purchased and tested by NGOs, 191 (90%) had mercury concentrations ranging from 1.18 to 74,800.00 ppm of mercury, way above the 1 ppm limit mandated for cosmetics by many governments as well as the Minamata Convention.
• Larger, multi-centric systemic studies on chronic mercury poisoning are required not just to understand the extent of the problem but also to persuade policy makers and regulators to clamp down on all cosmetics containing mercury at all.