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Journal of Environmental and Public Health
Volume 2012, Article ID 184745, 10 pages
Review Article

Arsenic, Cadmium, Lead, and Mercury in Sweat: A Systematic Review

1Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada K1H 8L1
2Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada K1Y 4E9
3Environmental Health Clinic, Women's College Hospital, Toronto, ON, Canada M5S 1B2
4Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada M5T 1W7

Received 16 July 2011; Accepted 23 October 2011

Academic Editor: Gerry Schwalfenberg

Copyright © 2012 Margaret E. Sears et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Arsenic, cadmium, lead, and mercury exposures are ubiquitous. These toxic elements have no physiological benefits, engendering interest in minimizing body burden. The physiological process of sweating has long been regarded as “cleansing” and of low risk. Reports of toxicant levels in sweat were sought in Medline, Embase, Toxline, Biosis, and AMED as well as reference lists and grey literature, from inception to March 22, 2011. Of 122 records identified, 24 were included in evidence synthesis. Populations, and sweat collection methods and concentrations varied widely. In individuals with higher exposure or body burden, sweat generally exceeded plasma or urine concentrations, and dermal could match or surpass urinary daily excretion. Arsenic dermal excretion was severalfold higher in arsenic-exposed individuals than in unexposed controls. Cadmium was more concentrated in sweat than in blood plasma. Sweat lead was associated with high-molecular-weight molecules, and in an interventional study, levels were higher with endurance compared with intensive exercise. Mercury levels normalized with repeated saunas in a case report. Sweating deserves consideration for toxic element detoxification. Research including appropriately sized trials is needed to establish safe, effective therapeutic protocols.