Most sports creams contain methyl salicylate, a toxic chemical which, absorbed in large enough amounts through the skin, can result in serious injury or, even in rare cases, in death from poisoning.

Tragically, that is exactly what happened, according to the New York City medical examiner, to a 17-year-old cross-country runner from Staten Island, New York, Arielle Newman. After a two-month investigation, the medical examiner ruled that Newman's death on April 3, 2007 was caused by the absorption through her skin of a fatal amount of methyl salicylate, apparently from Ben-Gay, IcyHot patches and a third, unknown product she was allegedly applying to treat muscle soreness.

While death from methyl salicylate absorption is rare (the New York medical examiner said it was the first time the office had reported a death from use of a sports cream), Newman's death is a tragic reminder that chemicals don't have to be ingested to pose a danger, that just because a medication is sold over the counter does not make it safe, of the critical importance of reading product labels and of not using any product to excess.

Sports Creams: Safety Tips

In the wake of Newman's death, here are some tips to parents about the use of sports creams:

• Don't assume that they are safe under all circumstances. Newman's mother, Alice, told the Staten Island Advance, that she could not believe her daughter's death had been caused by a sports cream. "I am scrupulous about my children's health," she told the newspaper. "I did not think an over-the-counter product could be unsafe."

• Follow label instructions and warnings. A spokeswoman for Johnson & Johnson, the makers of Bengay, told the Associated Press that the label on Ultra Strength Bengay states that consumers should apply the product no more than three or four times daily and should stop use and see a doctor if the condition worsens or symptoms persist for more than a week.

• Use in moderation. Newman "either lathered herself with it, or used way too much, or she used a normal amount and an abnormal percentage was absorbed into her body," Dr. Ronald Grelsamer, an associate professor of orthopedic surgery at Mount Sinai Medical Center, told the Associated Press. "As a rule, you want to use the smallest amount that works. If you find you are taking much more than everyone else around," he said, "then you need to try something else or consult a physician."

• Understand the health risks
  

  • Absorption of methyl salicylate can occur through the skin and death has resulted from systemic poisoning from the local misapplication of the drug. It is a common pediatric poison, and its use should be strongly discouraged.

  • Children with fever and dehydration should not use sports creams containing the chemical, as they are particularly prone to intoxication from relatively small does of salicylate, nor should they be given aspirin because of the risk of Reye's syndrome

  • Chronic use is more dangerous than one-time use

  • Exercise and heat can accelerate absorption

  • Probable lethal dose if ingested orally (note: methyl salicylate is used as a flavoring agent in chewing gum, baked goods, syrups, candy, non-alcoholic beverages and ice cream, and is also found in oil of wintergreen and vaporizer solutions) is between 1 teaspoon and 1 ounce for a 150-pound person.

• Recognize the symptoms of methyl salicylate poisoning. The following are symptoms of poisoning:Difficulty, rapid or no breathing
  

  • Ringing in the ears

  • Nausea or vomiting

  • Dizziness

  • Hallucinations

  • Drowsiness

  • Agitation

  • Convulsions

  • Collapse

  • Fever

• If your child has chronic pain, see a doctor. Too often these days, kids are under self-imposed pressure, or pressure from parents or coaches, to continue playing or practicing in pain. Kids should never continue playing or practicing if they are in pain and they need to know that hiding their injuries can have tragic consequences. That Newman was using excessive amounts of a sports cream to treat her pain should have been a red flag that she had an overuse injury for which treatment by a medical professional should have been sought.

• Switch to a sports cream that does not contain Camphor or Methyl Salicylate: Alternative sports creams are available. Look for products like Boiron's Arnicare cream containing Arnica Montana, a mountain plant that is used to relieve pain from bruises, stiffness and muscle soreness.