Allergen, possibly … and a poison

Mercury

As with lead, while a skin rash or generalized dermatitis is a symptom of mercury poisoning and while mercury is a top contact irritant, it is not listed in published lists of top causes of T-cell mediated contact dermatitis (this might possibly be because its use in cosmetics is highly restricted; more on this below). A 2002 study in the American Journal of Contact Dermatitis, however, does state “Mercury derivatives are frequent contact allergens.” Irritant or allergen, mercury remains highly toxic (the authors of a 2019 study on mercury coming from volcanic eruptions spewing matter into the atmosphere called it “the most genotoxic element on Earth”). Except in highly controlled conditions with experts, it should be avoided.

Mercury in skin bleaching creams

As late as the early 20th century, mercury was actually quite common in cosmetics. It became highly regulated in cosmetics due to its ability to cause toxicity. Skin bleaching products containing hydroquinone and mercury (ironic because long-term use can actually cause more darkening in skin and nails) are banned in many countries but are still sometimes available. Consistent exposure, even through skincare and makeup, can result in mercury poisoning, which can lead to kidney damage, brain damage, and death. Pregnant women, young children, and babies are the most vulnerable to mercury toxicity. And the danger is not limited to just the person using mercury-containing products. Family and other people living in close proximity can also become exposed by sharing fomites (towels and sheets) or breathing in vapors released by the products. Note that mercury is passed into breast milk.

In February 2023, the United States Food and Drug Association published a warning (“Mercury Poisoning Linked to Skin Products”) cautioning consumers against using products that contain mercury: “In the past few years, FDA and state health officials have discovered numerous products that contain mercury, and there have been cases in which people exposed to such products have had mercury poisoning or elevated levels of mercury in their bodies.”

In February 2023, the US FDA published another warning due to having “discovered numerous products marketed as skin lighteners that contain ingredients like mercury and/or hydroquinone.” It states:

“Often, mercury or hydroquinone is not declared on the product label. There have been cases in which people exposed to such products have had mercury poisoning or elevated levels of mercury in their bodies.”

Skin Products Containing Mercury and/or Hydroquinone, FDA.gov

Safer Options for Skin Lightening

Instead of choosing an actual toxin, try safer, clinically-proven practices and treatments to clear hyperpigmentations.

• Mercury is banned in many countries. Make sure that the skincare, makeup, or other product you are selecting does not contain mercury. Avoid ingredients such as “mercurio,” “calomel,” “mercuric,” and “mercurous chloride.” If ingredients are not listed, do not use the product.
• Avoid ingredients such as “mercurio,” “calomel,” “mercuric,” and “mercurous chloride.” If ingredients are not listed, do not use the product.
• Some products might contain mercury but not list them in the ingredients. Make sure you’re purchasing a product that is properly registered in your country’s FDA.
• Prioritize prevention: hyperpigmentations are notoriously stubborn and tend to recur even after lightening is achieved. Top photo-allergens to avoid include:
  • Fragrances (even masking fragrances)
  • Flavors
  • Topical steroids (not photo-allergens themselves but chronic use thins the skin barrier which can make it more susceptible to darkening and post-inflammatory darkening)
  • Dyes
  • Parabens
  • Preservatives
  • Plants and flowers such as lavender, mango, rose, eucalyptus, mint, lemon, and more
  • Essential oils and aromatherapy products, scented candles, incense
  • Chlorine (not just in pool water but also in household cleaning bleaches and disinfectant wipes)
  • Ask your dermatologist about other possible medications that are known to cause hyperpigmentations and about getting a photo-patch test to learn what you, in particular, are sensitive to and should avoid.
• Avoid photo-allergens (many allergens are also photo-allergens, meaning they can react with light to cause hyperpigmentations) in everything that you use. Try:
  • Essence Skin-Saving Hair-Body-Bath
  • Essence Skin-Saving Toothpaste and coconut oil as a mouthwash
  • Skintelligent Beauty Makeup (choose dye-free shades if you’ve patch tested positive to dyes)
  • Any VMV skincare, from cleansers to moisturizers and more.
• Consider an effective but less irritating hyperpigmentation treatment such as:
  • Kojic Acid, which is in Illuminants
• Use a sun and light screen daily, even indoors. Sometimes, even this alone — especially with a sun and light screen like Armada that is tested specifically for indoor and outdoor lights and rays — can already help lighten hyperpigmentations. Try Stay-On-Point in the USA.

Non-Bleach Household Cleaning

• Choose mercury-free bleach for household cleaning.
• Or, especially for sensitive skin, try bleach-free options.
• You can even make your own: take about 1/4 cup of clear vinegar and add 1/2 a tablespoon of Fawn & Launder or any of our hypoallergenic shampoos, and 3/4 cup warm water. Shake well in a spray bottle.

Other Potentials for Mercury Exposure

The risk of exposure to mercury is higher in occupations that include the processing of chemicals and metals where mercury is used, electrical equipment manufacturing, and mining.

For the rest of the general population, exposure of mercury can potentially come from:

• Some medications and medical items such as eye drops and ointments, ear drops, contact lens solution, nasal sprays, laxatives, antiseptics, mercurochrome, diuretics, hemorrhoid relief ointment, and blood pressure cuffs
• Some vaccines and antibiotics (although reactions, even delayed ones, are rare — do not skip a vaccine that you need or stop using an antibiotic you’ve been prescribed without your doctor’s guidance)
• Thermometers, barometers and some other measuring equipment
• Some veterinary products and dietary supplements
• Dental items (amalgam material)
• Electronics: batteries, monitors and LCD screens, older TVs (made before 1991)
• Household items such as bleaches, antiques, older appliances, automative parts (particularly in cars manufactured before 2003), Includes fluorescent bulbs, compact fluorescent light bulbs (CFLs), high intensity discharge (HID) lamps, ultraviolet lamps, neon lights
• Some bleaching creams (see “mercury in skin bleaching creams” above)
• In patch testing, if aluminum Finn chambers are used, mercury salts can react with them and result in irritant reactions

Other important safety information:

• Follow official safety guidelines when handling, keeping, or disposing of mercury and items that contain them such as thermometers, antiques, older appliances, etc. A great resource is the US Environmental Protection Agency’s guide “Mercury in Consumer Products.”
• If you have come into contact with mercury, follow these suggestions from the US FDA:
  • Thoroughly wash your hands and other parts of your body that have come in contact with products that contain mercury.
  • Contact your health care professional or a medical care clinic for advice. If you have questions, call your health care professional or the Poison Center at 1-800-222-1222; it is open 24 hours a day.
  • Before throwing out a product that may contain mercury, seal it in a plastic bag or leak-proof container. Check with your local environmental, health, or solid waste agency for disposal instructions. Some communities have special collections or other options for disposing of hazardous household waste.

Subscribe to VMVinSKIN.com and our YouTube channel for more hypoallergenic tips and helpful “skinformation”!

If you have a history of sensitive skin…

…don’t guess! Random trial and error can cause more damage. Ask your dermatologist about a patch test.

To shop our selection of hypoallergenic products, visit vmvhypoallergenics.com. Need help? Ask us in the comments section below, or for more privacy (such as when asking us to customize recommendations for you based on your patch test results) contact us by email, or drop us a private message on Facebook.

For more:

• On the prevalence of skin allergies, see Skin Allergies Are More Common Than Ever. 
• For the difference between irritant and allergic reactions, see It’s Complicated: Allergic Versus Irritant Reaction.
• For the difference between food, skin, and other types of reactions: see Skin & Food Allergies Are Not The Same Thing. 
• On the differences between hypoallergenic, natural, and organic, check out Is Natural Hypoallergenic? and this video in our YouTube channel. 
• To learn about the VH-Rating System and hypoallergenicity: What Is The Validated Hypoallergenic Rating System?

Main References: 

Regularly published reports on the most common allergens by the North American Contact Dermatitis Group and European Surveillance System on Contact Allergies (based on over 28,000 patch test results, combined), plus other studies. Remember, we are all individuals — just because an ingredient is not on the most common allergen lists does not mean you cannot be sensitive to it, or that it will not become an allergen. These references, being based on so many patch test results, are a good basis but it is always best to get a patch test yourself.

1. Audicana MT, Muñoz D, del Pozo MD, et al. Allergic contact dermatitis from mercury antiseptics and derivatives: study protocol of tolerance to intramuscular injections of thimerosal. Am J Contact Dermat. 2002 Mar;13(1):3-9. doi: 10.1053/ajcd.2002.29945. PMID: 11887097.
2. Sun, S,  Chang, J,  Jiang, X,  Gu, H.  Irritant contact dermatitis caused by cosmetics containing excessive mercury. J Cosmet Dermatol.  2022; 21: 6688– 6690. doi:10.1111/jocd.15010
3. Sofie Lindström et al. Volcanic mercury and mutagenesis in land plants during the end-Triassic mass extinction, Science Advances (2019). DOI: 10.1126/sciadv.aaw4018
4. DeKoven JG, Silverberg JI, Warshaw EM, Atwater AR, et al. North American Contact Dermatitis Group Patch Test Results: 2017-2018. Dermatitis. 2021 Mar-Apr 01;32(2):111-123.
5. DeKoven JG, Warshaw EM, Zug KA, et al. North American Contact Dermatitis Group Patch Test Results: 2015-2016. Dermatitis. 2018 Nov/Dec;29(6):297-309.
6. DeKoven JG, Warshaw EM, Belsito DV, et al. North American Contact Dermatitis Group Patch Test Results 2013-2014. Dermatitis. 2017 Jan/Feb;28(1):33-46.
7. Warshaw, E.M., Maibach, H.I., Taylor, J.S., et al. North American contact dermatitis group patch test results: 2011-2012. Dermatitis. 2015; 26: 49-59.
8. W Uter et al. The European Baseline Series in 10 European Countries, 2005/2006–Results of the European Surveillance System on Contact Allergies (ESSCA). Contact Dermatitis 61 (1), 31-38.7 2009.
9. Wetter, DA et al. Results of patch testing to personal care product allergens in a standard series and a supplemental cosmetic series: An analysis of 945 patients from the Mayo Clinic Contact Dermatitis Group, 2000-2007. J Am Acad Dermatol. 2010 Nov;63(5):789-98.
10. Warshaw EM, Buonomo M, DeKoven JG, et al. Importance of Supplemental Patch Testing Beyond a Screening Series for Patients With Dermatitis: The North American Contact Dermatitis Group Experience. JAMA Dermatol. 2021 Dec 1;157(12):1456-1465.
11. Verallo-Rowell VM. The validated hypoallergenic cosmetics rating system: its 30-year evolution and effect on the prevalence of cosmetic reactions. Dermatitis 2011 Apr; 22(2):80-97.
12. Ruby Pawankar et al. World Health Organization. White Book on Allergy 2011-2012 Executive Summary.
13. Misery L et al. Sensitive skin in the American population: prevalence, clinical data, and role of the dermatologist. Int J Dermatol. 2011 Aug;50(8):961-7.
14. Warshaw EM1, Maibach HI, Taylor JS, Sasseville D, DeKoven JG, Zirwas MJ, Fransway AF, Mathias CG, Zug KA, DeLeo VA, Fowler JF Jr, Marks JG, Pratt MD, Storrs FJ, Belsito DV. North American contact dermatitis group patch test results: 2011-2012.Dermatitis. 2015 Jan-Feb;26(1):49-59.
15. Warshaw, E et al. Allergic patch test reactions associated with cosmetics: Retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004. J AmAcadDermatol 2009;60:23-38.
16. Foliaki S et al. Antibiotic use in infancy and symptoms of asthma, rhinoconjunctivitis, and eczema in children 6 and 7 years old: International Study of Asthma and Allergies in Childhood Phase III. J Allergy Clin Immunol. 2009 Nov;124(5):982-9.
17. Kei EF et al. Role of the gut microbiota in defining human health. Expert Rev Anti Infect Ther. 2010 Apr; 8(4): 435–454.
18. Thavagnanam S et al. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy. 2008;38(4):629–633.
19. Marks JG, Belsito DV, DeLeo VA, et al. North American Contact Dermatitis Group patch-test results, 1998 to 2000. Am J Contact Dermat. 2003;14(2):59-62.
20. Warshaw EM, Belsito DV, Taylor JS, et al. North American Contact Dermatitis Group patch test results: 2009 to 2010. Dermatitis. 2013;24(2):50-99.
21. Verallo-Rowell V. M, Katalbas S.S. & Pangasinan J. P. Natural (Mineral, Vegetable, Coconut, Essential) Oils and Contact Dermatitis. Curr Allergy Asthma Rep 16,51 (2016) . https://doi.org/10.1007/s11882-016-0630-9.
22. Park G, Oh DS, Lee MG, Lee CE, Kim YU. 6-Shogaol, an active compound of ginger, alleviates allergic dermatitis-like skin lesions via cytokine inhibition by activating the Nrf2 pathway. Toxicol Appl Pharmacol. 2016 Nov 1;310:51-59. doi: 10.1016/j.taap.2016.08.019. Epub 2016 Aug 22. PMID: 27562088.
23. de Groot AC. Monographs in Contact Allergy, Volume II – Fragrances and Essential Oils. Boca Raton, FL: CRC Press Taylor & Francis Group; 2019.
24. De Groot AC. Monographs in Contact Allergy Volume I. Non-Fragrance Allergens in Cosmetics (Part I and Part 2). Boca Raton, Fl, USA: CRC Press Taylor and Francis Group, 2018.
25. Zhu TH, Suresh R, Warshaw E, et al. The Medical Necessity of Comprehensive Patch Testing. Dermatitis. 2018 May/Jun;29(3):107-111.

Want more great information on contact dermatitis? Check out the American Contact Dermatitis Society, Dermnet New Zealand, the Contact Dermatitis Institute, and your country’s contact dermatitis association.

Laura is our “dew”-good CEO at VMV Hypoallergenics and eldest daughter of VMV’s founding dermatologist-dermatopathologist. She has two children, Madison and Gavin, and works at VMV with her sister CC and husband Juan Pablo (Madison and Gavin frequently volunteer their “usage testing” services). In addition to saving the world’s skin, Laura is passionate about health, inclusion, cultural theory, human rights, happiness, and spreading (like a VMV cream!) goodness!