Foreword

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Acrodynia was recognized about 100 years ago and in the early part of the last century the condition was commonly seen in pediatric clinics. Teething powders containing calomel also were commonly recommended by physicians. It wasn't until an astute clinician noted the association between use of mercury-containing calomel in teething powders and the occurrence of acrodynia that mercury was suggested as the cause. In the 1940s the etiology was confirmed when elevated urine mercury concentrations were documented in children with acrodynia. Mercury was finally removed from teething powders in 1954, and acrodynia cases dropped precipitously. Deaths from acrodynia almost disappeared.

Although mercury is no longer used in teething powders, children continue to be exposed to it in a variety of other ways. Countries around the world now recognize mercury exposure as a major public health hazard. The most effective way to reduce the hazard is to eliminate the uses of mercury. In June of 2010 the United Nations Environment Programme convened a meeting in Sweden that was a first step toward a legally binding treaty to control mercury pollution. Over 130 countries participated in the initial discussions about how to minimize, and where feasible, eliminate mercury from use globally. The text of the proposed treaty will be discussed at a second meeting in Tokyo, Japan, in January 2011. The work on the treaty is expected to be completed before 2013. More information about the development of the treaty on mercury is available at http://www.epa.gov/international/toxics/mercury.html.

Clinicians can play an important role in teaching patients about the hazards of mercury exposure, advocating for discontinuing its uses, and diagnosing mercury poisoning. Because mercury poisoning is less commonly seen than it was in the last century, inexperienced clinicians may confuse it with other conditions, such as measles, scarlet fever, Kawasaki disease, or pheochromocytoma. A high index of suspicion and a good environmental history are needed to make the correct diagnosis. In this issue, Dr. Bose-O'Reilly and his colleagues summarize the sources of children's mercury exposures and provide useful information on the signs and symptoms and good illustrations of the rash that is seen among patients with acrodynia. I hope that you find it useful in your practice.