High levels of lead have been found in two tubes of a skin cream known as Diep Bao that’s advertised as treatment for eczema in young children. State and local health officials are warning parents to avoid using the product while its safety is investigated.

Two Portland-area children were recently found to have elevated blood lead levels. The children, one in Washington County and one in Multnomah County, are both younger than a year old. During investigations by state and local lead experts, parents of the children pointed to Diep Bao as the product they recently used on their babies’ faces to treat eczema, also known as atopic dermatitis, a condition common in young children that causes dry, itchy and inflamed skin.

Ryan Barker, Oregon Health Authority’s Childhood Lead Poisoning Prevention Program coordinator, said laboratory tests on samples of the product provided by the families showed the product in the Washington County case contained 9,670 parts per million (ppm) lead, while the Multnomah County sample contained 7,370 ppm lead. The Food and Drug Administration (FDA) has been alerted and is investigating. Only the two tubes of the cream have been tested so far, so whether lead is present in other tubes of Diep Bao is still being investigated.

Diep Bao is promoted primarily by online retailers in Singapore and Vietnam, with one seller advertising it as “a cream that supports skin problems such as eczema, heat rash, rash, redness, dry chapped skin, skin care, skin cooling, skin healing.” Health investigators say the product is manufactured in Vietnam.

OHA, Washington County Public Health and the Multnomah County Health Department are jointly investigating the cases. They are asking families who have the product to avoid using it while its safety is investigated. Parents can help the investigation by providing tubes of Diep Bao in their possession to investigators so the product can be tested. They also are asking parents to learn about the risks of exposure to other lead-tainted products and make sure children’s blood levels are tested if they have been exposed to them.

“We are concerned this product caused or significantly contributed to the elevated blood lead levels in these children,” Barker said. “Any product containing high lead levels should be considered extremely dangerous and parents should immediately stop using it on their children or any other family member.”

There is no Food and Drug Administration (FDA) regulatory limit on lead in medications, but for cosmetics it’s 10 ppm. This means the two creams that were tested contained nearly 1,000 times the maximum allowable amount of lead in cosmetics. It’s unclear whether Diep Bao is considered a cosmetic under federal law.

The Washington County case was found to have a blood lead level of 11.8 micrograms per deciliter (µg/dL), while the Multnomah County case had a blood lead level of 7.3 µg/dL. Oregon's case definition for lead poisoning has been a blood lead level of 5 µg/dL or greater, which is when public health agencies investigate and provide case management to families. However, out of an abundance of caution – and to align with lead poisoning definitions of the Centers for Disease Control and Prevention (CDC) and FDA – public health agencies in Oregon have recently begun investigating cases with blood lead levels above 3.5 µg/dL.

People with high blood levels of lead may show no symptoms, but the condition may cause damage to the nervous system and internal organs. Acute lead poisoning may cause a wide range of symptoms, including abdominal pain, muscle weakness, nausea, vomiting, diarrhea, weight loss, and bloody or decreased urinary output.

Children are particularly vulnerable to lead poisoning. If a child is exposed to enough lead for a protracted period (e.g., weeks to months), permanent damage to the central nervous system can occur. This can result in learning disorders, developmental defects, and other long-term health problems.

“If your child has a skin condition like eczema, consult with your health care provider about prevention and treatment options,” said Christina Baumann, M.D., Washington County health officer. "If you have been using this Diep Bao cream, please talk to your provider about getting a blood lead test for your child.”

Perry Cabot, senior program specialist at Multnomah County Health Department and an investigator on the lead exposures, said the lead poisoning cases were discovered through a combination of regular pediatric check-ups, parent engagement, and public health follow-up to “connect the dots.”

“All these factors highlight the importance of staying engaged in your children's health, whether it's you, your medical provider, or your local or state health program,” Cabot said.

OHA and county health officials are working with the FDA to investigate the cases and test more products as they become available. Until the source and scope of the lead contamination are better understood, local health officials are also asking anyone selling these products to stop selling them and remove them from their websites to protect their customers.

Local health officials are working with culturally specific community groups and other partners to warn residents of potential risks associated with the eczema cream. People who have a tube of Diep Bao, or other concerns about lead, can contact the following:

Multnomah County Leadline: 503-988-4000 or leadline@multco.us. Interpretation is free. Those submitting product will get instructions on where to drop it off. More information about lead is at leadline.org.
FDA: Consumers who have a complaint regarding the use of Diep Bao cream are encouraged to call the Oregon Consumer Complaint Coordinator or report the product through FDA’s Safety Reporting Portal.

Risk of lead

Oregon health care providers and laboratories are required by law to report certain diseases and conditions, including lead poisoning, to local health departments. On average, 270 Oregonians are diagnosed with lead poisoning each year; about a third are children younger than 6. The most common cases are due to ingesting paint and paint dust containing lead, but exposures from traditional cosmetics and informally imported spices have been identified.

For more information, visit the CDC’s Childhood Lead Poisoning Prevention Program page.

Source: Oregon Health Authority