By Meera Senthilingam, CNN
This story is part of 'White lies', a series by CNN's As Equals, investigating skin whitening practices worldwide to expose the underlying drivers of colorism, the industry that profits from it and the cost to individuals and communities. For information about how CNN As Equals is funded and more, check out our FAQs.
A woman in Minnesota lost part of her vision and inadvertently put her entire household at risk of mercury poisoning, most likely from using beauty products 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, also a mother, and how home visits conducted by the Minnesota Pollution Control Agency (MPCA) found high levels of mercury in her children's bedrooms, bedding, household towels and laundry area.
"People have no idea," 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 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 symptoms 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."
"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 out there 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.
At that time, the agency 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 beauty products the woman had bought at a local market, one of which was not labelled as skin whitening but is known to be used for this, 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 18,000ppm.
"There are limited outlets for availability, 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/liter -- more than nine times the level considered normal (5 micrograms/liter)| -- 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 meter (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/liter.
One of many families at risk
The woman's story is one of many in the state of Minnesota and other parts of the US in recent years where women and entire households are believed to have been exposed to inorganic mercury from the prolonged use of skin whitening products that fail to disclose they contain harmful levels of the toxic chemical.
The woman was "incredibly frustrated," said Batdorff. "She had bought things that didn't say lightening, thinking that they would be safe," said Batdorff.
A widespread issue
Screening studies by the biomonitoring team within the Minnesota Department of Health (MDH) in 2015 and 2019 also found elevated levels of mercury in the urine of multiple people who used skin whitening products, including pregnant women. Previously unpublished results from these studies shared exclusively with CNN show that follow-up home visits for some of these women revealed high levels of mercury vapor in the air -- particularly in their washing machines -- with readings as high as 1,800 and 2,000 ng/m3.
Lori Copan, Chief of the Exposure Prevention and Education Section at the California Department of Health reviewed the findings for the Minnesota mother and told CNN: "[The case of this woman] unfortunately is similar to others we have seen in California, with a person experiencing symptoms for years without adequate recognition of potential mercury toxicity from a skin lightening product by health-care providers." She added that her team has seen around one hundred cases of toxicity from people using these creams, or their family members.
"Anyone using a skin lightening product that contains mercury, unfortunately, is going to put the whole household at risk," said Batdorff. "There's no way to make sure that no contamination of the mercury will go to other household members. That's just not how mercury works."
'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, the pigment that gives color to skin. 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 hocame 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 different side effects."
For Batdorff and other experts, finding people early and removing the sources of mercury before they cause permanent damage is crucial.
"When we're thinking about exposures in pregnant women, women of childbearing age and babies and children, you know, we don't want people in those groups to be having higher mercury exposure," 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 need to focus on women who speak languages other than English and different ways of sharing the information, ideally through community partners."
Skin whitening: Toxic ingredients
Topical steroids are used to treat a range of skin conditions, including psoriasis and eczema, due to the drugs' anti-inflammatory effects.
Skin whitening is a potential side effect, which has led to topical steroid misuse.
The long-term use of steroids, or use without monitoring by a doctor, can lead to various side effects, such as rashes, pustules, hair growth on the skin, and infections.
The over-the-counter sale of potent corticosteroids is banned in many countries and territories worldwide, including the US, the UK, India and Hong Kong.
Over-the-counter sales are banned or regulated in multiple countries, including the US, South Africa, South Korea, UAE, the UK, the EU, Japan and Australia.
The US FDA recognizes that hydroquinone may be a carcinogen.
Mercury is a common ingredient found in skin whitening creams and soaps worldwide due to its bleaching effect.
Mercury salts block the production of melanin, leading to a lighter skin tone.
Mercury is found in both inorganic and organic forms in cosmetics.
The Minamata Convention on Mercury established a limit of 1 mg/kg (1 ppm) for cosmetics, including skin whitening products.
Products tested in a variety of countries in Africa, Asia, Latin America and North America have contained up to 40,000 parts per million (ppm) of mercury.
Source: Zero Mercury Group
Mercury is extremely toxic and the health effects from long-term exposure include kidney and liver damage, as well as a host of neurological problems, such as depression, anxiety and early childhood developmental issues.
Source: London Borough of Southwark (UK) World Health Organization
Previous data from the MDH has found Somali, Latina and Hmong populations in Minnesota -- who are among the largest cultural communities in the state -- to be at particular risk from mercury exposure in beauty products.
The mother in the case report was originally from Somalia.
Adawe added that many doctors miss the need to screen these women for mercury exposure unless they are familiar with the issue of skin-lightening practices in the Somali and other communities.
"I would say this is the number one possible source of mercury exposure for people in Minnesota," agreed Gilkeson at the MPCA. "It affects the individual who's using the product and affects their family or children and their community."
The state's department of health told CNN it hopes to work with additional clinics and health care providers to offer urine mercury screening as well as educate both health providers and the public -- particularly focusing on clinics who serve women who may be most at risk of exposure.
Many shop owners also unaware
Earlier this year, the city of Minneapolis ran a skin lightening education program working with East African communities at a popular community hub in the city of Minneapolis, the Karmel Mall as well as other malls in the area. The aim was to inform people, including shop owners and customers, about the risks of mercury found in many skin whitening and other beauty products as well as to test the wide range of items sold across the malls to help identify the products posing the most risk, and their countries of origin.
The team spoke with more than 200 vendors and customers and disposed of around 900 products containing high levels of mercury -- many of which were manufactured in Pakistan -- over the three months that the program ran, said Fatou Barry, program assistant on the project, who visited the mall almost daily during this time.
Barry said most vendors had no awareness of the products containing harmful ingredients like mercury and were "shocked" when they realized the risk to their community. Many others, however, closed their stores when they learned city officials were visiting, Barry said.
In a reflection paper describing the strategy and impact of her team's efforts, Barry wrote that the biggest taken away from the whole experience was how important it was to keep showing up and engaging with the community. "Passively sending or posting flyers wasn't nearly as effective as coming in and going [from] vendor to vendor," she wrote.
Skin whitening: The culture
Skin color preferences go back to slavery, when lighter-skinned people who were enslaved were likely to be related to their master and favored to work indoors, while darker-skinned people were sent to the fields.
Source: National Conference for Community and Justice
slavery
Research shows Hispanic people with darker skin tones are more likely to say they have experienced discrimination because of their race or ethnicity than those with lighter skin tones.
Source: Pew Research Center
discrimination
Experts suggest Jamaican society is divided by a "color-based classification of race" in which there are white, brown and black groups, which to some degree correlate with upper, middle and working class.
color-based classification
The fair-skinned ideal of beauty in Japan is illustrated in the Japanese proverb: "A white complexion is powerful enough to hide seven faults," meaning fair skin compensates for unattractive features.
fair-skinned ideals
In Sudan, skin bleaching is a common practice with women using homemade mixtures full of unknown and often harmful chemical ingredients.
homemade mixtures
Because lighter skin remains desirable in South Africa, Rwanda and Ghana -- where skin whitening products are banned -- illegal markets persist.
illegal markets
A need for better enforcement
To tackle the issue across affected communities, Nelson from the biomonitoring team believes a multi-pronged approach is essential. "The urine testing, the product testing and getting products off shelves. The community outreach and engagement," she outlined. "They all need different voices at the table about how to do that best and most effectively."
In addition to these approaches, Adawe stressed the need for better enforcement of regulations. "The products are widely available in ethnic malls like Karmel and the state has not actively regulated these products," she said. "I visited [a few months ago] to check if the products we tested that contained mercury are still available...and saw all the mercury containing skin-lightening products displayed on the shelves."
The MPCA is responsible for enforcing regulations on these products in the state, and issuing penalties. In response to Adawe's concerns, a spokesperson for the agency told CNN that the MPCA "prioritizes education and outreach efforts to help vendors identify and remove products from shelves and will take enforcement actions when appropriate."
They added that "skin-lightening creams present a unique challenge because their labeling doesn't often list mercury as an ingredient and each product must be tested to determine if mercury is present above the regulatory limit."
To further increase knowledge among affected communities, MDH has an awareness and education grant of up to $200,000 to fund various community organizations, NGOs and city health departments working in this space, including Adawe's.
"Through Beautywell we do training for health care providers and public health workers to understand about colorism, skin-lightening practice and ways they can identify the health impact of this practice," explained Adawe. "The use of skin-lightening products in the Somali community is high and so we need to continue do health education in this community and teach women to embrace their skin color."
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Credits:
Editors: Eliza Anyangwe, Lucy Benson
Design: Tiffany Baker, Tal Yellin, Will Mullery
Video: Elisa Solinas, Agne Jurkenaite, Ladan Anoushfar