A Systematic Review of Mercury Exposures from Skin-Lightening Products

BACKGROUND: The Minamata Convention on Mercury (Article 4) prohibits the manufacture, import, or export of skin-lightening products containing mercury concentrations above [Formula: see text]. However, there is a lack of knowledge surrounding the global prevalence of mercury-added skin-lightening products. OBJECTIVE: The objective of this study was to increase our understanding of worldwide human mercury exposure from skin-lightening products. METHODS: A systematic search of peer-reviewed scientific literature was performed for relevant articles in four databases (PubMed, Web of Science Core Collection, Scopus, and TOXLINE). The search strategy, eligibility criteria, and data-extraction methods were established a priori. The search identified 2,303 unique scientific articles, of which 41 were ultimately deemed eligible for inclusion after iterative screens at the title, abstract, and whole-text levels. To facilitate data extraction and synthesis, all papers were organized according to four data groups a) “Mercury in products,” b) “Usage of products,” c) “Human biomarkers of exposure,” and d) “Health impacts.” RESULTS: This review was based on data contained in 41 peer-reviewed scientific papers from 22 countries worldwide published between 2000 and 2022. In total, we captured mercury concentration values from 787 skin-lightening product samples [overall pooled central median mercury level was [Formula: see text]; interquartile range (IQR): 0.02–5.9] and 1,042 human biomarker measurements from 863 individuals. We also synthesized usage information from 3,898 individuals and self-reported health impacts associated with using mercury-added products from 832 individuals. DISCUSSION: This review suggests that mercury widely exists as an active ingredient in many skin-lightening products worldwide and that users are at risk of variable and often high exposures. These synthesized findings identify data gaps and help increase our understanding of the health risks associated with the use of these products. https://doi.org/10.1289/EHP10808