• The fascination with fair skin in Indian culture feeds the flourishing industry of skin fairness creams.

• Existing literature has already established an association between high mercury content in skin whitening products and membranous nephropathy (MN).

• The study included all patients diagnosed with NELL-1-MN in a private hospital in Kerala from July 2021 to September 2023.

• Heavy metal screening was done for those who had a positive history of fairness cream use.

• The study found that 13 out of 15 patients had applied fairness cream, with a median duration of application of 4 months.

• All the patients had nephrotic range proteinuria.

• 9 out of 11 patients had mercury levels higher than normal in blood, urine, or both.

• One patient with levels as high as  22.1 μg/L (normal range: 0.46–7.5 μg/L) showed a reduction to 2.42 μg/L within three months of stopping the application of the cream.

• The study emphasizes the need for further studies to strengthen the causation and to take measures to increase public awareness of the health effects of skin products.

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