What value does the cosmetics industry give to women's health?

A keratin-based hair straightening treatment led to severe acute kidney injury in young women in Israel. Why did these cases not have far-reaching consequences?

Glycolic acid derivatives in keratin-based hair straightening products are proving disastrous for young Israeli women

In Israel, most keratin-based hair straightening products contain glycolic acid derivatives. These could have a nephrotoxic effect if absorbed systemically. The increasing popularity of this hair styling method in recent years poses a serious risk factor for the health of otherwise healthy young women in the event that the glycolic acid derivatives are absorbed systemically. In July 2023, Bnaya et al. described 26 Israeli patients who had suffered acute kidney injury as a result of ‘Brazilian’ hair straightening. At the time, the research team hypothesised that the glycolic acid derivatives contained in hair straightening products were absorbed through the skin and subsequently converted into oxalate by the liver.2

For the design and evaluation of their retrospective study (n = 26), Bnaya et al. obtained their data from a total of 14 medical centres in Israel. The patients had received treatment with hair straightening products shortly before the onset of severe acute kidney injury (AKI) (period 2019-2022). The average age of the patients was 28.5 years, with the youngest patient being 14 and the oldest 58 years old. The patients were referred to us due to the following symptoms:

In 12 per cent of cases, dialysis became necessary. Despite all this, two patients had their hair relaxed again, resulting in the second ANV episode.3

Acute oxalate nephropathy caused by hair straightening product with a keratin base

A renal biopsy was performed in seven patients. In 86 per cent of the samples examined, intratubular calcium oxalate deposits were found. In 14.3 per cent, microcalcifications were visible in the tubule cells. Interstitial infiltrate was observed in 57 per cent of the samples, with all biopsies showing signs of acute tubular damage. According to these histological results, acute oxalate nephropathy was the predominant cause. The research group hypothesised that the absorption of glycolic acid derivatives during hair straightening and the subsequent metabolisation of the glycolic acid derivatives to oxalate were causally involved.2,4

Nephrotic syndrome caused by skin-lightening creams

If you take a closer look at the secrets of the beauty industry, you quickly realise that the true price of ‘beauty’ is endangering women's health in every conceivable way. And the problem is a big one in global terms, even if it receives little attention. The global market for skin-lightening products is a multi-billion-dollar industry. According to the WHO, 25-80 per cent of women in Africa, Asia, the Middle East and the Caribbean regularly use skin-lightening products. In India alone, such products account for more than 60 per cent of the dermatological products market. However, these products contain ingredients such as mercury, hydroquinone and kojic acid. They are used to reduce the concentration or production of melanin in the skin. Mercury is the most dangerous of these ingredients. In China and India, cases of nephrotic syndrome associated with the use of such products are regularly reported. In most cases, this is a phospholipase A2 receptor-negative membranous nephropathy (MGN).5-7

Facial cosmetics: a toxic cocktail on the skin for the perfect complexion

The products most commonly used by women are facial cosmetics. However, these can be contaminated with various toxic elements. After absorption through the face skin, they then travel through the blood vessels throughout the body and can thus cause damage in different places. In 2022, a study was published that looked at the evaluation of toxic elements (arsenic, lead, nickel, mercury and cadmium) in commonly used facial cosmetics (face powder, foundation, flash creams, moisturiser, eye shadow, lipstick, eyeliner, blush, mascara and sunscreen) . Among other things, they determined the margin of safety (MoS) for the cosmetics they researched.

The safety of a cosmetic product is primarily based on the safety of the ingredients that make it up. Calculating a margin of safety (MoS) is an important tool here: it serves as a safety buffer to ensure consumer safety. It is generally accepted that the margin of safety should be at least 100. Only then can this substance be considered safe for use in cosmetics. However, in the present study, the MoS value of selected toxic elements in all facial cosmetics – with the exception of eyeliners – was 3 to 4 times below the minimum value of 100 set by the WHO.3,8,9

Beauty may be painful, but is it worth it? Where does the beauty craze end and human reason begin? What value do women really have for the cosmetics industry? There are countless scientific case reports on various cosmetic products that show how cosmetics endanger women's health. The beauty craze has been ‘imposed’ on women from a young age, and has been for decades. Advertising posters have given way to TikTok influencers. These are designed to recruit young consumers who may not necessarily question the ingredients of the promising products.

As a doctor, you ask yourself: why do cosmetic products that jeopardise the health of people and the health of the environment continue to be marketed? Shouldn't someone regulate this? Isn't it the responsibility of the state to provide primary prevention for its citizens and to protect them from damage to their health?  As primary bearers of human rights obligations’, states are responsible for ensuring that the health of its citizens is not compromised. Isn't this the basic idea of the human right to health? Does this not also apply to women?10

Sources
  1. Robert T. et al. (2024). Kidney Injury and Hair-Straightening Products Containing Glyoxylic Acid. N Engl J Med. 2024 Mar 21;390(12):1147-1149. 
  2. Bnaya A. et al. (2023). Acute kidney injury and hair-straightening products: a case series. Am J Kidney Dis 2023;82(1):43-52.e1.
  3. Akhtar A, Kazi TG, Afridi HI, Khan M. Human exposure to toxic elements through facial cosmetic products: Dermal risk assessment. Regul Toxicol Pharmacol. 2022 Jun;131:105145.
  4. Abu-Amer N. et al. (2022). Acute Kidney Injury following Exposure to Formaldehyde-Free Hair-Straightening Products. Case Rep Nephrol Dial. 2022 Jul 11;12(2):112-116. 
  5. Meena P. et al. (2024). The unfairness of fairness creams: unveiling the toxic impact on kidneys of mercury in beauty products. Kidney Int. 2024 Sep;106(3):337-340. 
  6. Chan TYK. et al.(2020). Nephrotic syndrome caused by exposures to skin-lightening cosmetic products containing inorganic mercury. Clin Toxicol (Phila). 2020 Jan;58(1):9-15. 
  7. Abraham Tharakan PK. et al. (2022). Beautification Gone Awry: Membranous Glomerulonephritis Following Use of Skin Lightening Cream Containing Mercury. Indian J Dermatol. 2022 Nov-Dec;67(6):837. 
  8. https://www.cosmedesk.com/blog/posts/safety-evaluation-of-cosmetic-ingredients-risk-characterisation/
  9. https://www.sgs.com/en/-/media/sgscorp/documents/corporate/brochures/understanding-cpsr-personal-care-magazine-march-2014.cdn.en.pdf
  10. [German only] https://www.bpb.de/shop/zeitschriften/apuz/weltgesundheit-2020/318302/gesundheit-als-menschenrecht/#footnote-target-1