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Q & A for Mercury Poisoning Cluster Associated with Use of Aguamary Creams

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Q1: What is mercury?
A1: Mercury is a naturally occurring element that can exist as metallic mercury (“quicksilver”), inorganic mercury compounds, and organic mercury compounds. Metallic mercury has been used for decades in oral thermometers, wall thermostats, fluorescent light bulbs, electric light switches, batteries, dental “silver” or “mercury amalgam” fillings, and other purposes. Some inorganic mercury compounds such as calomel (mercurous chloride) and other mercury compounds have been used as laxatives, teething powders, acne creams, skin-lightening creams, or treatments for indigestion. Because of mercury’s high toxicity these uses have been banned by the U.S. Food and Drug Administration.

Q2: How may I be exposed to mercury?
A2: Because mercury occurs naturally in the environment, everyone is routinely exposed to low levels in their air, water, and food. However, some people may be exposed to higher levels of mercury through their individual activities, which may include:

  • Eating fish or shellfish containing elevated levels of Methylmercury,
  • Using inappropriate and/or outdated medical treatments containing metallic mercury or mercury compounds (as with calomel laxatives or teething powders),
  • Having large numbers of dental amalgam fillings in their teeth,
  • Breathing vapors from spilled mercury or having skin contact with mercury or its compounds in the home or workplace,
  • Participating in religious, cultural, or spiritual practices that use mercury,
  • Taking herbal remedies that contain mercury.
  • Using anti-aging, blemish-removing, or skin-lightening creams containing mercury.

Q3: How may my children be exposed to mercury?
A3: Children are particularly sensitive to the effects of mercury. The fetus will be exposed to mercury in the womb if the mother has been exposed to mercury. Infants also may be exposed when breast feeding from a mother who has been exposed to mercury. Older children may be exposed through direct skin contact with someone who has been using face or body creams containing mercury.

Q4: What has caused the recent publicity and concern about mercury?
A4: Hospitalization of a teenager in the Rio Grande Valley for mercury poisoning led to the discovery of a number of other individuals in that area who have been found to have elevated blood mercury levels. All of the people who had elevated levels of mercury reported using Aguamary cream products for blemish-removal or skin-lightening.

Q5: What types of products have been found to contain harmful amounts of mercury?
A5: So far all of the people with elevated mercury levels in their blood have reported using a family of creams called Crema Aguamary; this includes face creams, eye creams, and body creams. The creams are manufactured in Sinaloa, Mexico and are available in some farmacias and boticas across the border. Creams with that name also are sold over the internet; however, at this time we do not know where in the distribution chain the mercury was added.

Q6: What is Aguamary Cream used for?
A6: Aguamary creams are variously advertised for “anti-aging,” “cleansing,” “age spots,” “moles,” “large pores,” “birth marks,” “rosacea,” “warts,” “scars,” “under-eye circles,” “wrinkles,” “sun damage,” “skin-lightening,” “acne,” and/or “blemish-removal.”

Q7: How much mercury is in the Aguamary Creams?
A7: The Texas Department of State Health Services (DSHS), Environmental Sciences Branch Laboratory has tested 16 samples of Aguamary creams. All had elevated levels of mercury, some hundreds of thousands of times higher than permitted in skin care products in the United States. Ten samples of face and/or body cream contained mercury levels ranging from 56,000 to 131,000 parts per million (ppm), and six samples of a cream labeled for use around the eyes tested from 240 to 6,700 ppm of mercury. The U.S. Food and Drug Administration allows only trace amounts of mercury less than 1 ppm in cosmetics.

Q8: Is there a test to determine if the product I have been using contains mercury?
A8: Yes. Commercial laboratories are capable of testing for mercury in these cream products. However, we are not recommending any more testing of products at this time. Instead, if you have been using Aguamary Cream and have had any unusual symptoms, we recommend that you contact your healthcare provider or the Texas Poison Center Network at 1-800-222-1222 to see if you should be evaluated for mercury exposure.

Q9: What level is considered to be safe for skin-care products?
A9: The U.S. Food & Drug Administration has established a limit of 1 ppm for mercury in skin care products in the U.S. Cosmetics used only in the area around the eyes, may contain a preservative with mercury up to 65 parts per million (ppm) only if no other safe and effective preservative is available.

Q10: What are the signs and symptoms of mercury exposure in adults?
A10: Chronic exposure to mercury may cause extreme fatigue, weakness, insomnia, irritability, depression, anxiety, severe headache, tingling in the hands and feet, tremors, severe muscle aches in arms and legs, sores or ulcers in mouth, elevated blood pressure, excessive sweating, chills, discoloration and peeling on hands and feet, short-term memory loss, GI upset, nausea, abdominal pain, weight loss, or loss of sense of taste. Because mercury of all types tends to accumulate in the kidneys, these organs are prone to being damaged by excessive exposures, which can result in proteinuria, nephrotic syndrome, renal tubular acidosis, and acute renal failure.

Q11: What are the signs and symptoms of mercury exposure in children?
A11: Small children exposed to excessive mercury may experience severe pain in the extremities, photophobia, and pink discoloration of the hands and feet, in addition to, extreme fatigue, weakness, insomnia, irritability, depression, anxiety, severe headache, tingling in the hands and feet, tremors, severe muscle aches in arms and legs, sores or ulcers in mouth, elevated blood pressure, excessive sweating, chills, discoloration and peeling on hands and feet, short-term memory loss, GI upset, nausea, abdominal pain, weight loss, or loss of sense of taste. Because mercury of all types tends to accumulate in the kidneys, these organs are prone to being damaged by excessive exposures, which can result in proteinuria, nephrotic syndrome, renal tubular acidosis, and acute renal failure.

Q12: If I am pregnant and have been exposed to mercury, is my unborn child in danger?
A12: Your unborn child may be in danger if your exposure has been high enough. Mercury can interfere with brain development in the fetus and very young children. Depending on the levels of mercury to which the developing brain was exposed, the effects can vary from subtle decreases in IQ up to the severe and crippling neurologic defects. If you are pregnant and have been using the Aguamary cream products, you should be evaluated by your healthcare provider to check your blood mercury level.

Q13: Is there a medical test to show whether I have been exposed to mercury?
A13: Yes. Blood and urine samples are the most reliable and accurate method of testing for mercury exposure. The appropriate samples can be collected in a physician’s office and sent to a qualified laboratory for analysis. These tests can determine if you have been exposed to above-average levels of mercury.

Q14: If I think my children or I have been exposed to these products, what should I do?
A14: DSHS recommends that people who have been using Aguamary cream products should stop using the creams. If you are concerned about your or your child’s mercury exposure, contact your healthcare provider or the Texas Poison Center Network at 1-800-222-1222. If you do not have a primary care physician, you should go wherever you normally go to receive medical care. Based on your product usage and symptom history, your doctor can decide if it is necessary to test your blood or urine for mercury.

Q15: Where can I go to be tested for mercury exposure?
A15: If you are concerned about mercury exposure, you may contact your regular healthcare provider or a qualified private laboratory for a blood test for mercury. Based on your product usage and symptom history, your doctor can decide if it is necessary to test your blood or urine for mercury.

Q16: If I have any of the products that have been identified, how should I dispose of them?
A16: People who have remaining Aguamary products are encouraged to dispose of them at a household hazardous waste facility. If there is no facility available in the community, the product may be tightly closed, bagged, and discarded with household garbage for routine landfill disposal. Please do not dispose of the product in the city sewage system (do not put it down the drain or in the toilet).

Q17: Is there a treatment for mercury exposure and where can I get it?
A17: Yes. The most important first step is to stop using the cream immediately. DSHS recommends that go to your primary healthcare provider for evaluation to see if treatment is necessary. Then, based on your symptom history and blood or urine test results, your doctor can decide whether you could benefit from treatment for mercury toxicity. Generally, the treatment involves a 10-14 day course of medicine (pills) to eliminate the excess mercury from your body. This treatment should only be performed under the direction of a physician.

Q18: What if my physician does not know what to do for mercury exposure?
A18: Your physician can call the Texas Poison Center Network at 1-800-222-1222 for assessment and treatment advice.

Q19: If I am a healthcare provider, who do I call for information on treating patients with mercury exposure?
A19: You may call the Texas Poison Center Network at 1-800-222-1222 for help in the evaluation of your patient and recommendations about treatment of mercury poisoning.

Last updated September 02, 2011