It’s standard practice to warn women about the harmful health effects of smoking, weight gain, mercury in fish, and even the medications they take. But maybe you didn’t know that cosmetics, too, can be a potential health hazard. All women need to be aware of the potential toxins in the personal-care products they use so they can practice preventive health care.
Nurses have long been advocates for environmental health, dating back to Florence Nightingale’s early work linking a clean environment to health. Today that legacy continues through the American Nurses Association’s Center for Occupational and Environmental Health. The Center works at the state and federal levels to bring environmental policy issues to the forefront, educating legislators and policy makers about the impact of environmental toxins on the health of the public and of nurses.
Few safety regulations
As you know, the Food and Drug Administration (FDA) requires rigorous testing before approving drugs for therapeutic use. But it might surprise you to learn there are no safety standards and virtually no restrictions for chemicals used in personal-care products. Unlike with drugs, no safety reviews are required before these products go to market, and no reporting requirements exist for adverse events related to their use.
Because the cosmetics industry has been charged with monitoring its own products, testing for long-term health effects is done rarely, if at all. Many of these products contain known carcinogens (formaldehyde, diethanolamine, talc), reproductive toxins (mercury, lead, toluene), and hormone disruptors (phthalates, parabens). Without regulations or standards, most of these products fly under the safety radar. (See the box below.)
The vast majority of ingredients in personal-care products (89%) haven’t been tested for safety. These include chemicals in makeup, shampoo and other hair-care products, soap, perfume, deodorants, and skin lotions. In the testing that has been done, roughly one-third of the products were found to have at least one ingredient linked to cancer, and up to 80% had impurities that aren’t required to be listed as ingredients. These chemicals have been found in human urine, breast milk, and breast tumors.
If you were giving a drug that was a known carcinogen or could cause birth defects, you’d certainly warn the patient of this risk (even if the FDA were to approve the drug in the first place). Likewise, it’s simply good healthcare practice to teach women of childbearing age about the risks of personal-care products for themselves and their children.
Penetration enhancers and microparticles
Another factor that has eluded study and regulation is the large number of personal-care products containing penetration enhancers. These deliver the product past the protective dermis, where it’s absorbed into the bloodstream and carried to organs that previously wouldn’t have been exposed. For instance, lotions, moisturizers, and sunscreens may contain sulisobenzone, ceteareth-20, or micronized particles that carry ingredients into subdermal layers.
Nanotechnology has created such tiny microparticles that we can no longer assume the skin will act as a protective barrier. In her groundbreaking book Not Just a Pretty Face: The Ugly Side of the Beauty Industry, Stacy Malkan points out: “Animal studies show that some nanoparticles can penetrate cells and tissues, move through the body and brain, and cause biochemical damage. As one example, carbon fullerenes—also called bucky balls, and currently being used in some moisturizers—can cause brain damage in fish, and even low levels of exposure can be toxic to human liver cells.”
Clearly, nanotechnology introduces an additional layer of exposure beyond that of traditional products. And without testing, reporting, and oversight, we won’t know the full impact of this delivery enhancement system until it’s too late to limit exposure.
What does Europe know that we don’t?
The European Union (EU) banned certain phthalates known to cause reproductive defects after a 2002 study found phthalates in 80% of the products tested. The EU has now banned more than 1,000 chemicals from personal-care products. By comparison, the FDA has banned only 10.
With such an obvious lack of regulation, some states are trying to ban the worst toxins at the state level. California and Washington have banned phthalates from toys, and several states seek to ban these chemicals from personal-care products. Clearly, we’re seeing growing interest in legally limiting toxins in products from which they’re absorbed by the body. The chemical industry has strenuously resisted these efforts by lobbying and filing lawsuits in states that attempt to pass protective bills.
With the growing concern over harmful chemicals, some companies have voluntarily signed an agreement to eliminate known toxins from their products—the Compact for Global Production of Safe Health & Beauty Products. A list of signers is available at http://www.safecosmetics.org/.
Who is most at risk?
Women of childbearing age are at risk in several ways. Women use more personal-care products than men. Additionally, many women work in production and service aspects of the cosmetics industry. Many toxins, such as mercury, lead acetate, and dibutyl phthalate, cross the placenta, exposing the fetus. Phthalates and parabens are hormone disruptors, putting the fetus at risk for reproductive defects, such as male genital effects. Others substances, such as lead, are neurotoxins linked to developmental delays and learning or behavior problems.
Women need to be warned about these risks, just as they need to be warned about mercury in tuna. Women most at risk from toxin exposure are those who:
- work in a cosmetics industry where they’re exposed to these compounds for hours each day, such as nail salons, hair salons, and spas
- are pregnant or breastfeeding and work in the above settings
- are pregnant or breastfeeding and use many personal-care products and cosmetics daily
- work in the manufacturing of cosmetics or plastics.
Except through personal use, nurses typically aren’t exposed to cosmetic toxins in high levels. But nurses working in clinical settings that use plastic products or toxic medications or cleaners, and women working in factories that expose them to high chemicals levels should take steps to protect themselves from exposure. Risks can be cumulative—and keep in mind that women may be exposed to environmental toxins in the workplace, at home, in the community, and through the personal-care products they use.
What can nurses do?
You can take action in your care setting to bring this issue to the attention of female patients. In inpatient settings, you can connect with patients at a particularly teachable moment, as they recover from whatever has led to their hospitalization.
Nurses in outpatient settings see patients on a regular basis for routine health care, where awareness of product toxicity can be folded into a typical preventive visit. Here are ways to do this:
- Ask patients what kind of work they do and what chemicals and materials they handle every day.
- Inform women who may be trying to get pregnant that chemicals that might not have an immediate effect on them could damage the fetus.
- Learn about the common toxic ingredients in personal-care products, and advise women to read labels on the products they buy for themselves and their families.
- Make available a list of the companies that have signed the Compact for Global Production of Safe Health & Beauty Products, so women will have an idea of companies that make safer products (available at www.safecosmetics.org).
- Go to http://www.safecosmetics.org/ and print the “Unmasked” brochure, which explains the risks of beauty products. Also direct them to other helpful websites. (See the box below.)
|Resources on safer personal-care products
The websites below list safer personal-care products:
- Write or e-mail large cosmetic companies and ask them to sign the Compact so you can recommend them to your patients as responsible manufacturers.
- Urge your healthcare facility’s gift shop to stock only cosmetics that are accepted by the Campaign for Safe Cosmetics.
Women who learn about toxins in personal-care products can extend their awareness to toxins in other products as well. Women do most of the purchasing for themselves and their households, and most want to know how to keep themselves and their families healthy. By raising their awareness about toxic products, you can help them make healthier choices for everyone in their sphere of influence. Pregnant women and new mothers commonly are eager to learn ways to maximize their children’s health and may be highly receptive to suggestions about avoiding toxins.
Healthy is beautiful
Nurses who work in women’s healthcare settings are in a prime position to raise awareness of the toxic properties of personal-care products. Women listen to us as professionals whose job is to promote their well-being. With the pressure our culture places on women to be “beautiful,” emphasize to patients that health adds more to beauty than any cosmetic. Help them find safe personal-care products that won’t raise the risks of cancer or birth defects. Eventually, this will be routine health information, just as we now discuss the risks of smoking and alcohol consumption.
We can have a long-term impact on the health of women and their children by educating ourselves and our patients about the hazards of chemicals in the products we use every day—and steering them to safer alternatives. Now that we know, it’s time to spread the word.
Hubbs AF, Mercer RR, Benkovic SA, et al. Nanotoxicology—A pathologist’s perspective. Toxicol Pathol. 2011;39(2):301-324. Morgantown, WV: Health Effects Laboratory Division, National Institute for Occupational Safety and Health.
Langseth H, Hankinson SE, Siemiatycki J, Weiderpass E. Research reports: perineal use of talc and risk of ovarian cancer. J Epidemiol Community Health. 2008;62:358-360. doi:10.1136/jech.2006.047894.
Lorenz C, Von Goetz N, Scheringer M, Wormuth M, Hungerbühler K. Potential exposure of German consumers to engineered nanoparticles in cosmetics and personal care products. Nanotoxicol.2011;5:12-29.
Malkan S. Not Just a Pretty Face: The Ugly Side of the Beauty Industry. Gabriola Island, BC: New Society Publishers; 2007.
Pak VM, McCauley LA. Risks of phthalate exposure among the general population: implications for occupational health nurses. AAOHN J. 2007;55(1):12-17. www.slackjournals.com/article.aspx?rid=34131. Accessed March 24, 2011.
Pauwels M, Rogiers V. Human health safety evaluation of cosmetics in the EU: a legally imposed challenge to science. Toxicol Appl Pharmacol. 2010;243(2):260-274.
Kate Bracy is a nursing staff development specialist for Public Health—Seattle & King County in Seattle, Washington. A freelance medical writer on women’s and children’s health, she is the author of The Everything Health Guide to Menopause, and The Complete Idiot’s Guide to Sexual Health and Fitness. Ms. Bracy would like to thank the Environmental Health Education Center at the University of Maryland School of Nursing for providing support for the writing of this article through an Environmental Health Writer’s Retreat for Nurses, made possible by a generous grant from the Beldon Fund.