RESUMEN
BACKGROUND: In Cambodia, there is widespread use of skin-whitening creams containing levels of mercury that exceed Association of Southeast Asian Nations (ASEAN) guidelines by up to 35,000 times. Mercury in skin-whitening creams threatens to compromise the health of Cambodians. OBJECTIVES: It is important to provide essential information on sources of mercury so that Cambodians can avoid exposure to elevated levels of mercury and to support informed management of consumer goods. METHODS: Students were directed to buy selected skin-whitening creams that were then sampled with replication in 2011 and 2015 and processed with X-ray fluorescence (XRF) at the University of Health Science (UHS), Phnom Penh, Cambodia. DISCUSSION: The analysis of skin-whitening creams in Phnom Penh in 2015 was compared to analyses in 2008 and 2011 and showed that several creams produced in Asia no longer contain mercury. However, skin creams produced in Phnom Penh continue to use mercury and counterfeit products also are contaminated with mercury. Vendors occasionally identified Vietnam as a source of counterfeit products, but often the source was unknown. Mercury continues to be the metal of greatest concern in skin creams. Creams with more than 1,000 µg/g of mercury are a common cause of dermatitis (27% of cases). A new XRF analyzer was also able to detect more lead and arsenic than that used in analyses performed in 2011, and these two metals also exceeded ASEAN guidelines. Arsenic contamination also reflected the presence of bismuth in creams. CONCLUSION: Some producers of skin-whitening creams in Thailand, China and Taiwan appear to be aware of the risks of mercury contamination and have modified their products. However, other producers of skin-whitening creams continue to use mercury. XRF analysis allows for rapid screening of mercury in cosmetics and should be used to gather additional information on mercury content in cosmetics in support of public health efforts to stem the import, export and sales of skin creams containing mercury.