Cosmetics Safety

      The safety of cosmetics has recently been called into question by consumer watchdog groups and more recently even the US federal government has looked into closer regulation of the industry. These are interesting developments given the tremendous safety record of cosmetics manufacturers. Nevertheless, it is worthwhile examining cosmetic safety from a dermatologic standpoint as many physicians are asked questions about the ability to use cosmetics on diseased skin and while pregnant.

      It may surprise many to know that cosmetics really are regulated as the coloring agents that can be incorporated are strictly controlled. This control was specified as part of the US Food, Drug and Cosmetic Act of 1938. The only uncontrolled category of products is actually soap. All other skin care products and cosmetics are covered by some regulatory document except cleansers. The regulation of cleansers was not undertaken as there was concern that this would increase the cost of these products and have a detrimental effect on hygiene and infection control.

      Control of the cosmetics industry began with the recognition that some products were tainted with lead, mercury, and arsenic. One of the most common bleaching creams, known as skin whitening creams at the time, introduced in the 1930s contained mercury and another contained arsenic. It was the introduction of these dangerous products that led the federal government to recognize the need to protect the common good from these hazards. This type of protection is very important, as the quickest way to whiten skin is to induce a state of anemia, which is how some of the skin whitening products worked!

      This article will examine cosmetic safety from a historical perspective looking at the development of cosmetics and how they are currently perceived. At the end, it is my hope that you will have greater respect for the safety testing that done by all large cosmetic companies to insure the proper performance and consumer safety of their products.

      The Earliest Cosmetics

      The earliest cosmetics were not actually creams, liquids, or gels. They were cloth patches designed to cover facial blemishes known as beauty patches. These patches were developed and became popular in the 1600s to cover permanent facial scars left on those in Europe who survived smallpox epidemics. These were black silk or velvet pieces shaped like stars, moons and hearts that were carefully placed about the face. Patch boxes, the forerunner of the mirrored facial compact, were carried everywhere to keep replacements handy should a patch fall off in public. The wearing of patches evolved into an unspoken language: a patch near a woman’s mouth signaled flirtatiousness, a patch on a woman’s right cheek indicated she was married, a patch at the corner of a woman’s eye announced smoldering passion, etc.

      From these early facial ornaments to cover facial scarring, a theatrical product was developed known as French White. This cream was a big improvement over dusting the skin with loose powder and was used to whiten the skin and cover scarring on the face, neck, and arms. It consisted of white powder dissolved in a liquid vehicle that dried to a thin film over the body, but was easily removed with rubbing and sweat discoloring clothing and making a mess. In order to increase the ability of the cosmetic to stay on the skin with sweating, “grease paints” were developed with pigments and fillers suspended in oily vehicles for theatrical use. An adaptation of these early grease paints reach high popularity in the consumer market when Max Factor developed cake make-up, which he patented in 1936. This product provided excellent coverage, a velvety look, and added facial color. The consumer cosmetics category was born and has expanded tremendously over the last 75 years.

      Eye Cosmetics Safety

      The safety of eye cosmetics is an important consideration as they frequently are either accidentally introduced or migrate into the eye. Eyelid cosmetics have been used by women and men since 4000BC when green malachite powder was heavily applied to the upper and lower eyelids accompanied by dark kohl eyeliner paste composed of powdered antimony, burnt almonds, black copper oxide and brown clay ocher. Ground beetle shells were added to produce glitter. However, now the coloring agents that can be used around the eyes are strictly regulated. No coal tar derivatives can be used, only approved purified natural colors or inorganic pigments as set forth in the Food, Drug and Cosmetic Act of 1938 are allowed. Table 1 lists the coloring agents that are government approved.

      The same types of restrictions also apply to eyelash cosmetics, more commonly known as mascaras. Coal tar derived colors are also prohibited. Therefore, mascara colorants must be selected from vegetable colors or inorganic pigments and lakes. Colors employed include iron oxide to produce black, ultramarine blue to create navy and umber (brown ochre) or burnt sienna (a mixture of hydrated ferric oxide with manganic oxide) or synthetic brown oxide to create brown. However, it is important to note that only coloring agents are specified, not preservatives or other ingredients. This is where the controversy arises regarding cosmetic regulation.

      Lip Cosmetics Safety

      The safety of the coloring agents used in lipsticks has received a great deal of attention due to the inevitable entry of lipsticks into the mouth. The Food and Drug Administration divides certified colors into three groups: Food, Drug and Cosmetic (FD & C) colors, Drug & Cosmetic (D&C) colors, and External Drug & Cosmetic colors. Only the first two groups can be used in lipsticks. The External Drug & Cosmetic colors can only be used in locations where they are not likely to enter the mouth.

      There has been some popular press about the contamination of lipstick pigments with lead. This could be perceived as an issue on the surface, but is a non-issue when investigated more deeply. The red pigments used in lipsticks may contain extremely minute amounts of lead, but nowhere near the amount found in old paints where breathing the lead dust or eating the lead-containing paint result in heavy metal poisoning. The consumer would have to eat thousands of tubes of lipstick annually to achieve lead poisoning from lipsticks. As with everything, it is a matter of degree. Persons who eat large quantities of red lipstick should be careful.

      Preservatives and Cosmetics Safety

      Perhaps the biggest area of controversy surrounds the use of preservatives in cosmetics. Animals that are fed large quantities of preservatives typically do not enjoy a long life. This is not surprising as the primary role of antimicrobial preservatives is to destroy bacteria and prevent contamination. The risk of transferring infection from cosmetics contamination is much bigger than the risk of using minute amounts of the preservative on the skin. Most people do not drink their facial foundation by the bottle, which is how animal testing is performed to determine safety and carcinogenicity. Furthermore, the risk of contaminating cosmetics by sticking dirty fingers into the jar or transferring an ocular infection from one eye to the other via a mascara wand is much larger.

      There has been a movement as of late to eliminate preservatives from cosmetics, however, it should be recognized that there is no such thing as a preservative-free commercially made cosmetic. Most cosmetics are not used until 3-6 months or longer after they have left the manufacturing facility. This means some form of preservation is necessary. If the product does not contain water, it can be preserved with lower preservative levels, since water is necessary for microbial growth. Many products that label themselves as preservative free actually contain preservatives, but the ingredient falls under a different category. For example, phenoxyethanol has a lovely rose scent and may be used as a fragrance ingredient when in reality is it a preservative. Many spices, such as clove essences, can be used for a combination of fragrance and preservation. Finally, it is also possible to lower the preservative concentration by special packaging. Many of the newer facial foundations are dispensed from a jar affixed with a one-way valve top. This valve prevents oxygen and anything outside the jar from entering the jar.

      In many ways, preservatives are the consumers’ best friend insuring product stability and longevity until the jar is emptied. Preservatives are listed on the ingredient disclosure usually within the last 1-3 ingredients. Since ingredients are listed in order of concentration, this means that the preservative is the ingredient present in lowest concentration. It interesting to think that man has fought over salt and spices to preserve food in the pre-refrigeration era and many groups are now trying to restrict preservation of cosmetics.

      Safety Testing of Cosmetics

      Why have there been so few instances of adverse events associated with the use of cosmetics? Because cosmetics are safe. Think of how many people use large numbers of cosmetics on a daily basis and how few problems arise. Why are cosmetics so safe? Because large cosmetic manufacturers spend tremendous resources formulating safe products, searching for quality ingredients, designing packaging to maintain product purity, and writing labeling to insure that consumers use the product properly. Most reputable manufacturers do safety testing on their products prior to marketplace introduction. This safety testing may include eye instillation, repeat insult patch testing, cumulative irritancy testing, and safety-in-use testing. Many companies also test their products on sensitive skin subjects, including those with a variety of dermatologic conditions such as eczema, rosacea, atopic dermatitis, etc.

      Why are so many resources devoted to cosmetic testing? Because a product that causes problems in the marketplace tarnishes the reputation of a company and erodes consumer confidence. This means that every product they manufacture is subject to question and results in lost sales and lower revenues. No company wants to loose its reputation on a problematic product. It is perhaps the power of the consumer marketplace that drives cosmetic safety, which is an inherent advantage of an open competitive marketplace.


      This discussion begs the final question. Is it necessary to legislate additional cosmetic safety? For large international companies, additional safety legislation is unnecessary as there is not much more that could be enforced above and beyond the safety that is already built into each and every product. For products purchased from third world countries over the Internet, yes, these cosmetics may be problematic. Would increased US legislation have an effect in promoting the safety of products purchased outside the US over the Internet? No. Simply put, don’t buy cosmetics on line from small manufacturers. Stick with nationally and internationally marketed brands. The best safety in built into products manufactured by companies who have a reputation at stake. Second, don’t buy products that are compounded or do not come in commercial tamper proof packaging. No one can make a cosmetic that is any better than those commercially marketed. Third, do not purchase products for use that are questionable when traveling abroad. Look for recognizable brands.

      Cosmetic Breakouts

      Can makeup cause breakouts? This is a common concern of women who enjoy wearing cosmetics. Of course, cosmetics are worn to cover up acne, which may cause more acne, which means more cosmetics need to be worn, which may cause more acne, etc. The breakouts of acne due to cosmetics is known by the Latin term “acne cosmetica.”

      A breakout due to cosmetics is a controversial topic in dermatology, but there are certain substances that may cause acne in some people. These ingredients include: octyl stearate, isocetyl stearate, sodium lauryl sulfate, mineral oil, petrolatum, sesame oil, and cocoa butter. If you are having trouble with acne from cosmetics, you may wish to pick products that avoid these ingredients. The ingredients can be found on the packaging and are listed in order of decreasing concentration.

      Many cosmetics are also labeled as noncomedongenic and nonacnegenic. Noncomedogenic means the cosmetic does not cause blackheads and nonacnegenic means the cosmetic does not pus bumps and pimples. If you have acne problems, look for cosmetics that have these two words on the packaging.

      Many people also note breakouts following the use of sunscreens. This problem typically is seen with numerous pimples and pus bumps on the face. This may not actually be acne, but sweat getting into the skin. Many water resistant sunscreens stick to the skin very well to prevent removal with water, but they almost stick too well and clog the sweat ducts that release sweat onto the skin surface. If you have this problem, you might want to avoid water resistant sunscreens.

      Acne from cosmetics sometimes means people embark on a complex regimen of multiple cleansers, moisturizers, and ancillary skin care products. This is not necessary. Sometimes using too many products can cause skin irritation that may look a lot like acne. If you are having acne problems, it might be best to stick to fewer skin care products and simplify your regimen. Sometimes less is better.

      Even after age 30, women can still get acne and cosmetics may be implicated. Some acne in women around ages 40-50 can be related to fluctuating hormones and the onset of premenopause and perimenopause and not necessarily cosmetics. Most acne found in mature women is on the lower face and neck and characterized by deep painful hard red lumps. This type of acne is not due to cosmetics.

      Expensive Cosmeceuticals: Money Well Spent?

      Patients and fellow dermatologists frequently ask me if expensive cosmeceuticals are money well spent. Is the cream contained in the jar worth the high price? Or, is the jar worth more than the cream? Or, is the collector edition box really the value? These are all excellent questions given that the skin care segment priced above $150 is the strongest growth category in the cosmeceutical market. Compare this with the average $32.50 price for currently marketed cosmeceuticals. The global prestige beauty market generates $36 billion annually, of which Western Europe accounts for $14 billion and North America for the remaining $12 billion. This is greater than the gross national product of most developing countries. A truly staggering amount.

      At present, it appears that there is no growth ceiling on the cosmeceutical market. Newer exotic and high tech formulations continue to enter the marketplace at an astoundingly quick pace. Why do people buy these products? Does it make them feel good to spend a lot of money on a fancy cream? Do they think more expensive products yield better results? Is it a yearning for youth? I am not sure. Even the best Madison Avenue marketing firms do not fully understand what it takes to create a blockbuster cosmeceutical, or all products in this segment would be hugely successful.

      This article examines some of the newly popular high priced skin cosmeceuticals by taking a close look at “what’s in the jar” to justify the cost. It is hoped that this information will help dermatologists understand this rapidly growing cosmeceutical market segment.

      Sea Kelp

      If you ever went swimming in the Pacific Ocean, you no doubt stepped on some slimy sea kelp. Rather than wiping it from your feet, you should have rubbed it all over your face. Sea kelp is the pricey ingredient in a new moisturizer introduced by La Mer, an innovator in high priced cosmeceuticals. The sea kelp is harvested in San Diego and flown to La Mer’s formulation laboratories in New York where it is fermented for 4 months. Following the fermentation process, the material is placed in magnetized tubes. It is mixed with cultivated algae and mixed into a cream that is hand filled into small jars. The kelp and algae are felt to act as antioxidants and anti-inflammatories for individuals with sensitive aging skin. The product sells for $2,100 for a 3-week supply making it the price leader in the cosmeceutical market.


      Rather than eating that spoonful of caviar, it might be more financially rewarding to put it on your face. La Prairie has developed a $500 jar of cream that contains a rare caviar obtained in the Caspain sea from the beluga sturgeon during the natural birthing process. The caviar is supposed to have a cell format similar to human skin allowing the amino acids to speed up collagen production. The expense of the caviar is due to its regulation under the endangered species act and the fact that the caviar must be harvested fresh and immediately transported to the laboratory for processing to preserve the amino acids. In addition to caviar, the pricey cream also contains superoxide dismutase to function as an antioxidant.

      Growth Factors

      Growth factors are a huge area of research with new sources appearing daily in the cosmeceutical realm. Plant growth factors were the basis for Kinetin, a product marketed to dermatologists several years ago for office dispensing. The focus has now expanded to animal derived growth factors either from fibroblast culture media or the most recent source from breast milk of nursing cows in the first two weeks after birth. During this time, the breast milk is said to be very rich in growth factors that play an important role in tissue formation. The growth factors apparently signal the production of collagen and elastin. These bovine growth factors have been converted to a dehydrated powder that is packaged in tiny frozen vials along with a serum. The powder is thawed and mixed with the serum prior to nightly facial application. The product is sold by DDF at the price of $1000 for a 28-day supply.

      Another product, marketed by Revive for $1500 a jar, contains keratinocyte growth factors in combination with telomerase. It is said to increase keratinocyte production by eight times over baseline. The growth factors contained in this formulation are bioengineered in the laboratory and are not derived directly from plant or animal sources.


      Other bioengineered raw materials include neuropeptides. These are produced in the laboratory to mimic the effect of endogenous neurotransmitters. The production of the peptides is extremely costly. One neuropeptide found in the N. V. Perricone line costs $15,000 a kilogram, which is enough to produce 100 bottles of product. This neuropeptide-containing cosmeceutical sells for $570

      Red Arctic Tocol Cranberry

      A rather expensive botanical extract can be obtained from the red arctic tocol cranberry. This berry contains a complex rich in omega-3 fatty acids and vitamin E. It is said to increase the production of amino acids thereby enhancing skin repair. This product is marketed by Orlane and costs $470 a jar.


      Another interesting botanical ingredient is marketed as part of the SK-II line for $300 a jar. The cream contains pietra, which is composed of amino acids and an emollient cell lipid complex. It is a rare raw material obtained through the fermentation process of a specific yeast. Pietra was discovered as part of the manufacturing process for sake, an Oriental alcoholic beverage. It is placed in a carefully constructed moisturizing base.


      All of the high priced creams discussed in this article contain expensive rare ingredients that require special transport and handling to maintain their activity. Certainly, the manufacturer must pass this expense onto the consumer. The question is whether it is the rare ingredient or the other constituents of the moisturizing vehicle that produce visible improvement in the facial skin. It is said that there can be no placebo controlled studies of cosmeceuticals. This is because the vehicle is most definitely an active. Vehicle controlled studies remain valuable, however, since they provide a clear understanding of whether the expensive ingredient provides added skin benefits above and beyond the vehicle effect. But, is this really important? If the vehicle provides all the benefit, is there any harm in creating some marketing buzz by finding a rare ingredient from the far reaches of the globe to increase the price of your product. Isn’t this part of the mystique of the cosmetics realm? This certainly is a matter of opinion.

      The final important message for the dermatologist to consider after evaluation of the formulation of these pricey creams is to help the patient make an informed purchase. Know exactly what is in the jar and its monetary and cutaneous value. There is no universal definition of “money well spent.”

      The Art of Eyelash Beautification

      What cosmetic would most women take if they were marooned on a desert island? Sunscreen? Lipstick? Facial foundation? No, the correct answer is mascara. Mascara is an interesting concoction designed to lengthen, darken, curl, and elongate eyelashes. You may ask why so much attention is focused on these fine short hairs that emanate from the upper and lower eyelids with a relatively short anagen growth cycle. The answer is that long eyelashes are considered a sign of female beauty

      Women have long prized long eyelashes. The original method for elongating the appearance of the eyelashes was the eyelash curler. This device, popularized in the 1960s, looked like a medieval torture device. The eyelashes where placed in a scissor-like contraption with rubber stoppers. The device was closed and the eyelashes bent upward with a more acute angle. This reduced the natural curve of the eyelashes and allowed the eyelashes to look longer. Eyelash curlers can still be purchased today, but the newer models are heated, much like a curling iron. The warmth reforms the water-deformable bonds in the eyelash hairs, allowing the eyelashes to curl.

      The next major development in eyelash elongation was a cosmetic known as mascara. The original mascara worn by women of antiquity was made from antimony trisulphate, more commonly known as kohl. Since the safety of kohl around the eyes was questioned, a more modern formulation was developed composed of sodium stearate soaps and lampblack. The product was mixed with water, stroked from the cake with a brush, and applied to the eyelashes. This formulation produced immediate eye irritation from the sodium stearate but was later reformulated with triethanolamine stearate. Beeswax was subsequently added to allow the product to be somewhat water-resistant.

      Even though the use of mascara dates to Biblical times, newer formulations are worth discussing for their dermatologic implications. This article reviews the different modern mascara formulations pointing out the patient issues for type.

      Mascara Colors

      The US Food, Drug, and Cosmetic Act strictly control the colors that can be used around the eyes. Coal tar colors are prohibited, thus mascara colorants must be selected from vegetable colors or inorganic pigments and lakes. Pigments that are used in modern mascaras include iron oxide to produce black, synthetic brown oxide to produce brown, ultramarine blue to create navy, and brown ochre to create yellowish-brown, and burnt sienna to produce dark brown.

      Basic Mascara Formulations

      Mascaras are available in several modern formulations listed in Table 1. Each formulation has certain advantages and disadvantages in a given population. Cake mascaras are the oldest and the most difficult to apply. Cream mascaras were introduced next, but liquid mascaras applied from an automatic tube dominate the modern marketplace. The utility of each variety in different patient populations is discussed next.

      Cake Mascara

      The original cake mascara was composed of soap and pigments compressed into a cake. The cake was stroked with a water-moistened brush and applied to the eyelashes. Unfortunately, this formulation was not water-resistant and smudged with tears or perspiration.

      The old cake formulations have virtually disappeared, but black powdered compressed eye shadow has taken its place. Many cosmetic companies, such as MAC (Estee Lauder), make a black powdered compact that can be moistened with a wet brush to form a paste. The powder adheres to the brush and then can be stroked over the eyelashes where it dries to a thin film to pigment the eyelashes. While most patients would find this mascara formulation cumbersome, patients with multiple allergies and extremely sensitive eyes will find the black cake mascara a welcome alternative.

      This type of mascara has few irritants and allergens, no fragrance, minimal preservatives, and low risk of contamination as long as the cake dries between uses. Persons who claim they cannot wear any kind of commercially available mascara usually can tolerate the modern black cakes. Persons with ocular rosacea may also find this type of mascara helpful because it does not block the eyelash follicular ostia or provide a substrate for bacterial growth.

      Cream Mascara

      The cake mascaras gave way to the cream mascaras. The cream mascaras were made from pigment suspended in a vanishing cream base that were brushed from a tube onto the eyelashes with better water-resistance abilities than their cake predecessors. However, the cream mascara quickly disappeared when the automatic tube was developed that could accommodate only liquids. No cream mascaras remain on the market today.

      Liquid Mascara

      Liquid formulations dominated the mascara market once the automatic tube was introduced. The automatic tube consists of a cylinder with a brush that can be repeatedly inserted and removed through a aperature to deliver a metered amount of product to the eyelashes.

      Water-based Liquid Mascara

      The first liquid mascaras developed were water-based. Water-based mascaras are so named because they are formulated of waxes (beeswax, carnauba wax, synthetic waxes), in addition to pigments (iron oxides, chrome oxides, ultramarine blue, carmine, titanium dioxide) and resins dissolved in water. They are classified as oil-in-water emulsions. The water evaporates readily, creating a fast-drying product that thickens and darkens the lashes. The product is water-soluble, allowing for easy removal, but unfortunately smudges with perspiration and tearing. Some water-based mascaras are labeled "water-resistant" if they contain an increased amount of wax or a polymer to improve adherence of pigment to the lashes.

      Water-based mascaras are easily contaminated with bacteria, which readily grow in water, and must include preservatives, usually parabens. Thus, these products may potentially cause an allergic reaction in paraben sensitive individuals; however, water-based mascaras are generally the least sensitizing of the mascara types. Some patients may experience a contact irritancy from the emulsifiers required to maintain the pigment in solution.

      Of all the mascaras, the water-based products are the best for persons with sensitive skin, eye problems, or ocular rosacea. They do not require a special solvent for removal and can be thoroughly removed with soap and water. This prevents the accumulation of mascara in the eyelash follicular ostia, which can be a contributing factor to sebaceous gland occlusion and the initiation of disease. When in doubt, recommend that patients select a water-based mascara if they complain of eye irritation or other eye cosmetic-related problems.

      Solvent-based Liquid Mascaras

      Many consumers, however, want a mascara that does not smudge with water contact. Water-based mascaras can migrate with tearing and perspiration. This created the need for the next mascara formulation that was solvent-based. Solvent-based mascaras are formulated with petroleum distillates to which pigments (iron oxides, chrome oxides, ultramarine blue, carmine, titanium dioxide) and waxes (candelilla wax, carnauba wax, ozokerite, hydrogenated castor oil) are added. A special removal solvent must be used to remove the mascara, which can also remove the sebum from the tender periorbital skin. The most common cause of cosmetic related eyelid dermatitis is use of eye cosmetic removal products. Sometimes puzzling refractory steroid-dependent eyelid dermatitis can be easily treated by switching to a water-based mascara.

      Incomplete removal of the waterproof mascaras can cause problems with eyelash breakage. The mascara stiffens the eyelashes, which are crushed when sleeping on the pillow. Patients that are experiencing eyelash breakage, identified by loss of the tapered eyelash tip, should be encouraged to use water removal mascaras to avoid unnecessary loss.

      Solvent-based mascaras may be preferred in patients who have recurrent eye infections because the mascara does not support bacterial growth. Preservatives are still added, but microbial contamination is not a great problem since the petroleum-based solvent is antibacterial. Solvent-based mascaras are also preferred in patients who have problems with their longwearing contact lenses. The longwearing lenses are designed to absorb water to maintain their hydration. This means that they will also absorb water-soluble mascaras, which can damage or stain the lens. This is not as much of a problem with the solvent-based mascaras.

      Water/solvent Hybrid Mascaras

      The newest mascaras combine both solvent-based and water-based systems to form either a water-in-oil or oil-in-water emulsion. The idea is to create an optimal product that thickens with a short drying time like the water-based mascaras, but provides waterproof lash separation like a solvent-based mascara. Some of these combination mascaras contain a film-forming polymer that dries to form a tube around the eyelash. The eyelash tube thickens, darkens, and elongates the eyelashes better than any other formulation. For persons with eyelash loss, the polymer mascaras provide the best cosmetic camouflage. Some of these new mascaras are applied with a complex brush or silicone comb designed to coat each surface of the eyelash and prevent the eyelashes from clumping.

      Lash Curling Mascaras

      Another advance in mascara technology is the introduction of the automatic lash curling mascara. This type of mascara is designed to curl the eyelashes without the use of the mechanical eyelash curler previously discussed. These mascaras also are based on polymers. As the polymer dries, it contracts and this increases the curvature of the hairs making them appear longer.

      Lash Thickening Mascaras

      In addition to lash curling, mascaras are also formulated to thicken and elongate the lashes. Some mascaras incorporate small fibers into the formulation that can stick to the eyelashes making them appear thicker and longer. They are not hair growth products. With the introduction of topical drugs for lash elongation (Latisse, Allergan), the focus on eyelash growth has increased. Eyelash growth drugs can be used with mascaras, but the eyelash growth topicals can dry the eyelashes due to the presence of the drug solvent. There are some eyelash conditioning mascaras that may prevent solvent eyelash damage resulting in eyelash fracture.

      Medical Problems Related to Mascara Use

      The most significant medical problem with mascara is infection. Pseudomonas aeruginosa corneal infections have been reported, which can compromise visual acuity. Staph epidermidis and staph aureus organisms can proliferate in contaminated mascaras, which is why mascara tubes should not be shared and should not be used for more than 3 months. Infections are more common if the eyeball is traumatized with the infected mascara. As mentioned previously, individuals with recurrent bacterial infections due to colonization should probably select solvent-based mascaras.

      Mascara pigment can also cause a conjunctival pigmentation, if the mascara is washed into the conjunctival sac by lacrimal fluid. This colored particulate matter can be observed on the upper margin of the tarsal conjunctiva. Histologically, the pigment is seen within macrophages and extracellularly with varying degrees of lymphocytic infiltrate. Electron microscopy suggests that ferritin, carbon, and iron oxides are present within the tissues. Unfortunately, there is no treatment for the condition, which fortunately is usually asymptomatic.

      Luscious Lips

      Luscious lips are considered a sign of female beauty. While lip fashion may change over the time, the definition of beautiful lips is constant. Well-proportioned lips should begin at one pupil and extend to the opposite the pupil. Lipsticks can be used to elongate the lips and correct suboptimal proportions. They can also be used to add shine, attract attention, and coordinate colors. Lip cosmetics have been used since 7000 BC when the Sumerians adorned the lips of their male and female royalty. The art of lip adornment was passes through the generations from the Egyptians to the Syrians to the Babylonians to the Persians to the Greeks to the Romans to present day civilizations. Usually plant materials, such as hybrid saffron or brazilwood were used to obtain a reddish color. The earliest true lipsticks consisted of beeswax, tallow, and pigment.

      Modern lipstick was introduced in the 1920s when the “push-up” holder, still used today, was invented. Lipsticks can create or assist in the treatment of lip conditions. This article focuses on the various types of lip products and their value in dermatology.

      Lipstick Formulation

      Lipstick is an extruded rod of color dispersed in a blend of oils, waxes, and fats packaged in a roll-up tube. The ratio of the oils and waxes is varied by the cosmetic chemist to arrive at the final attributes of the product. For example, a lipstick designed to camouflage lip imperfections must be long wearing. Elevating the wax concentration, reducing the oil concentration, and increasing the pigment concentration can increase the length of time the color remains on the lips. Lipsticks can also be used to treat nonactinic chelitis by providing higher lip emolliency. This formulation would be composed of a low wax and high oil concentration to produce a smooth creamy lip feel.

      Waxes are used to adhere the lip color to the lip. The waxes commonly incorporated into lipstick formulations are white beeswax, candelilla wax, carnauba wax, ozokerite wax, lanolin wax, ceresin wax, and other synthetic waxes. Usually, lipsticks contain a combination of these waxes carefully selected and blended to achieve the desired melting point. Oils are then added to soften the wax and add shine to the lips. The oils that can be used include castor oil, white mineral oil, lanolin oil, hydrogenated vegetable oils, or oleyl alcohol. The oils are also necessary for dispersion of the pigments.

      Various types of coloring agents are used in lipsticks in addition to the waxes and oils previously discussed. Recently, the safety of these coloring agents has been questioned, since a consumer watchdog group announced that several red lipsticks possessed detectable lead levels. The colors used in all cosmetics, including lipsticks, must be approved by the FDA. The FDA divides certified colors into three groups: Food, Drug, and Cosmetic (FD & C) colors, Drug & Cosmetic (D&C) colors, and External Drug & Cosmetic colors. Only the first two groups can be used in lipsticks. The External Drug & Cosmetic colors can only be used in locations where they are not likely to enter the mouth.

      Companies that manufacture lip cosmetics purchase their individual ingredients from suppliers. The cosmetic company typically receives a certificate indicating that the ingredient purchases meets certain standards. On top of this safeguard, most companies also perform internal testing to insure ingredient purity. There are many checks and balances to prevent the inadvertent contamination of cosmetics.

      Specialty Lipsticks

      There are a variety of lipsticks designed for unique consumer needs. Since lipsticks can be used for camouflaging, moisturizing, and photoprotection, there are formulations designed specifically for each need. An evaluation of these special needs products is important, as the dermatologist is likely to encounter patients who can supplement their lip therapy with proper lipstick selection.

      a. Long Wearing Lipsticks

      Individuals who have a lip deformity or problems with lipstick bleeding due to upper and lower lip rhagades may find a long wearing lipstick helpful. Basically, the lipstick stays in place once applied and does not migrate because it stains the lip. These lipsticks should be used in persons who are undergoing lip filler enhancement where not all of the lines can be filled or when the lines cross from the perioral skin onto the vermillion.

      Long wearing lipsticks employ indelible coloring agents to stain the lip. Indelible coloring agents include bromo acids, such as fluoresceins, halogenated fluoresceins, and related water-insoluble dyes. The most commonly used indelible coloring agent is acid eosin, a tetrabromo derivative of fluorescein. Acid eosin, also known as bromo acid or D&C Red No. 21, is naturally colored orange, but changes to a red salt at a pH of 4. Conditions present on the lip change the orange lipstick to a vivid red indelible stain that is long lasting. This accounts for the red color of all long wearing lipsticks.

      The biggest problem with long wearing lipsticks is that they dry the lips and precipitate chelitis. For this reason, long wearing lipsticks should not be used in persons with dry lips, as the lip xerosis will worsen with continued use of a lip stain. It is also possible to develop an irritant contact dermatitis to bromo acid containing lipsticks. In patients who have unexplained lip dryness and irritation, it may be worthwhile to recommend the discontinuation of long wearing lip products.

      b. Lip Balms

      An important variant of a lipstick is a lip balm. Lip balms do not contain pigment and are not used for decoration of the lips, but rather to provide moisturization of the lips and protection from the sun and cold. These products form a moisture-resistant film over the lips and act as an occlusive moisturizer to prevent water loss from the transitional mucosa. They usually contain a mixture of mineral oil, wax, and dimethicone. Lip balms may also contain organic sunscreens. Most lip balms have an SPF in the 15-30 range. Higher SPF lip balms are difficult to develop because the organic filter concentration would need to be increased and these filters have a horrible bitter taste. Yet, lip balms remain an excellent source of photoprotection in persons with actinic chelitis, leukoplakia, or a history of photo-induced lip cancer.

      The proposed four-star rating system for UVA photoprotection unfortunately works poorly for lip products. Even though UVA protection is important for the lip transitional mucosa, no product could achieve a three or four star rating because the lip balm would taste so bad no one could stand to wear it on their lips. Determining a rating system for lip balm products is one of the controversial areas of the new sunscreen monograph.

      There is a great deal of information on the Internet about the “addictive” potential of lip balms. Some consumers claim that they are addicted to lip balm, carry a tube in their pocket at all times, and must reapply the lip balm several times an hour. I did some research into this phenomenon several years ago and determined that patients were not addicted to the lip balm, but rather the waxy feel of the lip balm on the lips. It was a sensory rather than functional addiction. The lip balm did not precipitate further lip dryness, but created a warm moist feel immediately after application, that disappeared as the product remained on the lips. This necessitated the frequent reapplication as the film dissolved.

      c. Lip Gloss

      Another popular product to moisturize the lips is lip gloss. Lip gloss is different than lip balm as it does not contain waxes, but only oils and dimethicone. Lip gloss is most popular among adolescents who may select lip gloss as their first cosmetic. It adds shine, smell, and taste to the lips, but not necessarily moisturization. Lip glass migrates rapidly off the lip and is not a good choice in mature individuals. Additionally, some of the oils may be comedogenic. The dermatologist should about the use of lip gloss in acne patients with refractory vermillion border comedones.

      Lip gloss has seen a resurgence with the popularity of film forming polymer lip sticks. The polymer dries to a hard pigmented film on the lips, but is extremely drying. To prevent chelitis and add shine, many polymer lip products are copackaged with a lip gloss for frequent application, the next topic of discussion.

      d. Polymer Film Lipsticks

      Another method for enhancing the ability of a lip color to remain on the lips is through the creation of polymer films. Polymer film lipsticks are the newest introduction into the lipstick market. These lip products are packaged as two tube products where one end contains the lip color and the opposite end contains a lip gloss or balm. The pigmented polymer is applied first and allowed to dry followed by the moisturizing gloss or balm. These products stay on until peeled or rubbed off.

      For persons who need a long wearing lip product for camouflage purposes, the polymer film lipsticks are wonderful. They form an opaque film, which can cover pigmentation or vascular abnormalities of the lip. Another layer of camouflage can be added by putting a creamy opaque lipstick on top for moisturization and shine.

      The polymer lip products can be used to artistically draw on the lips, if they are asymmetric or too small. The polymer film sticks well to any skin surface, but best results are obtained when combined with a lip liner. The lip liner forms an even edge that can be painted over with the polymer film applicator. As opposed to lipsticks that are rubbed from a waxy stick, polymer film lip products are stroked across the lips with an angled sponge brush. This requires a steady hand for successful application.

      e. Lip Liners

      As mentioned previously, the new polymer lip products are best combined with a lip liner. Lip liners are thin extruded pigmented rods encased in wood or placed in an automatic pencil-type holder. Their formulation is similar to lipsticks, except that stiffer waxes with higher melting points are used with minimal oil. This creates an extremely hard rod that applies a thick layer of pigment to the lips. Lip liners are used to define the outer edge of the lips and are valuable in reconstructing a normal lip contour. The thick wax layer applied around the lips also prevents creamier lip products from bleeding. Lip liner is usually selected one to two shades darker than the lipstick.

      Lip liners are indispensable in persons who require lip definition or lip enhancement. They can nicely aid in lip definition for women who have undergone lip augmentation with fillers. Lip liner can also be used to temporarily draw lip proportions prior to filler injections to be sure that the patient is comfortable with the proposed lip size.

      f. Opaque Lipsticks

      Opaque lip cosmetics can be used over polymer lip products to prevent inevitable lip dryness. An opaque lip cosmetic is also preferred in patients who require lip camouflaging. The opaqueness is due to incorporation of high titanium dioxide levels in the lipstick. Titanium dioxide provides the best coverage of all the white pigments, including zinc oxide. It must be ground to a fine powder to enable smooth application of the lipstick. It also adds color brightness to lip cosmetics and is used to create pastel shades. Opaque lipsticks are the best lip protection for females with actinic chelitis. They can nicely protect the lip transitional mucosa after cryosurgery or lip advancement for reconstruction following lip cancer surgery.

      g. Tooth Whitening Lipsticks

      Another new category of lipsticks is tooth whitening lipsticks. These are sold primarily in drug stores. The name may be misleading, however, since the lipstick does not actually whiten the teeth like the popular tooth whitening kits containing peroxide. These lipsticks have a bluish-red color that makes the teeth appear white due to the color contrast.

      Lip Cosmetics and Allergic Contact Dermatitis

      Lipstick can be a cause of allergic contact dermatitis. The lipstick ingredients reported to cause allergic contact dermatitis include: ricinoleic acid, benzoic acid, lithol rubine BCA (Pigment Red 57-1), microcrystalline wax, oxybenzone, propyl gallate and C18 aliphatic compounds.

      The most common cause of allergic contact dermatitis in lipstick is castor oil. Castor oil is found in all lipsticks. It is used to dissolve bromo acid dyes,,, however the bromo acid dye eosin (D&C Red No. 21), is also a cause. If a patient has recurrent allergic contact dermatitis to many different types and brands of lipstick, castor oil allergy is almost always the problem. Many of these women still want to wear lipstick. An excellent alternative is one of the polymer lipsticks previously discussed. These products do not contain castor oil.


      Lipsticks are useful for cosmetic adornment, but can also be used by the dermatologist to facilitate the healing of a variety of lip conditions. For example, actinic chelitis can be minimized by using a sunscreen-containing lip balm or an opaque lipstick. Remember that an opaque lipstick has an unlimited SPF, since the transitional lip mucosa is completely protected. Lip abnormalities can be minimized by selecting a polymer lip product combined with a lip liner. Finally, patients who experience problems with lip swelling following the use of lipsticks, may be allergic to castor oil. Lipsticks and lip balms are to the lips what hand cream is to the hands. Both are important therapeutic adjuvants in the treatment of dermatologic disease.

      Lovely Lips

      Lip problems are common in males, females, adults, and children. They can be related to a variety of causes including lip licking, irritation, allergy, sun damage, and dry skin.

      What are chapped lips?

      Chapped lips are inflammation of the lips. This inflammation may be due to chronically sun damaged lip skin, which leads to chronic lip peeling. This is perhaps the most common cause of chronic chapped lips in men. Alternatively, chapped lips may be due to an allergic reaction to cosmetics. The most common culprit is castor oil, which is found in the majority of lipsticks. Irritation from lip licking may also contribute. Lastly, there may be individuals who have defective oil production from the tiny oil glands found on the periphery of the lip. These oil glands, also known as Fordyce spots, appear as yellow dots within the red part of the lip. These individuals could be viewed as having dry lip skin.

      What are the typical treatments for dry lips?

      The typical medical treatment for extremely dry lips is the use of low potency steroid ointments. These ointments are applied twice daily to the lips for two weeks and then discontinued to prevent thinning of the lip skin.

      What is a possible cosmetic treatment for dry lips?

      In the female patient, lipsticks can be utilized as an effective treatment for dry lips. Opaque lipsticks can decrease the amount of sun reaching the lips to prevent sun damage. Some lipsticks even contain sunscreens to provide protection.

      Lipsticks are mixtures of waxes, oils, and pigments in varying concentration to produce different types of lip products. For example, a lipstick designed to remain on the lips for a prolonged period of time is composed of high wax, low oil and high pigment concentrations. On the other hand, a product designed for a smooth creamy feel on the lips is composed of low wax and high oil concentrations. Smooth creamy lipsticks are the best choice for patients with dry lips

      The waxes found in lipsticks are white beeswax, candelilla wax, carnauba wax, ozokerite wax, lanolin wax, ceresin wax and other synthetic waxes. Usually, lipsticks contain a combination of these waxes carefully selected and blended to achieve the hardness or softness of the lipstick. Oils are then selected, such as castor oil, white mineral oil, lanolin oil, hydrogenated vegetable oils or oleyl alcohol, to form a film to apply to the lips. The oils provide the silky lipstick feel, making the lips smooth and soft. The oils also stop water loss from the lips stopping dryness and cracking.

      Several types of coloring agents are used in lipsticks. Some lipsticks contain stains, known as bromo acids that allow the lipstick to wear 4 or more hours. While these lipsticks are great for long wearing color, they can dry the lips. Long wearing lipsticks should not be worn by people with dry lips.

      How can lipsticks cause allergy problems?

      Castor oil, found in almost all lipsticks, is a cause of allergy to lipsticks in some people. If you are having trouble with blisters on your lips after wearing lipstick, you may have a castor oil allergy.

      How are lip balms best used for dry lips?

      Lip balms are an important part of dry lip treatment. They can be viewed as moisturizers for the lips. Their role in reducing water loss and creating an environment for healing cannot be ignored. If dry lips are chronic, continued use of night time lip balm may be recommended to prevent recurrence. The lips are at rest at night and lip balm has the greatest effect when applied at this time.

      Is it possible to become addicted to lip balm?

      One of the most interesting controversies regarding the use of lip balm is the perception that people can become “addicted” to lip balm use. Everyone has seen someone who applies lip balm every 30 minutes and thinks they may have an obsessive-compulsive disorder. It is not possible to become addicted to lip balm, but it is possible to become accustomed to the waxy feel the lip balm leaves behind on the lips requiring frequent application.

      What’s New in Colored Cosmetics?

      Lipsticks, facial foundations, and cosmeceutical treatment creams have little to do with dermatologic disease, yet patients frequently ask if these cosmetics offer skin benefits. It is amazing to consider the technology included in some of these cosmetic formulations to create illusion and improve appearance. For this reason, I think they are worthy of discussion. Have you ever wondered how products erase undereye lines? Is this possible? Have you ever wondered how lip plumping lipsticks work? How can they claim to use hyaluronic acid effectively in a noninjectable form? Have you ever wondered if age defying facial foundations really turn back the clock? How do they create the illusion of younger skin? These are rather interesting questions with equally interesting answers. This article will deal with some of the most significant developments in colored cosmetics.

      Undereye Line Erasing Cosmetics

      You may have noticed an increase in the number of cosmeceutical manufacturers advertising undereye line reducing products in our professional journals. While I find this an unusual place to advertise products without presenting clinical data, I think it is worthwhile to survey the most popular ingredients incorporated into undereye moisturizers to deliver these antiaging benefits. The methods for improving the appearance of the undereye tissues cosmetically include reducing blood flow, applying topical astringents, changing tissue optics, and changing the refractive index of the air stratum corneum interface.

      Probably the most interesting method for improving undereye bags is a theoretical reduction in blood flow. One of the reasons the undereyes appear puffy is poor venous outflow of the undereye vasculature. If less blood reached the undereye tissues, perhaps there would be less tissue edema. A derivative of shark cartilage high in mucopolysaccharides has been commercialized and is known as MDI complex. This complex has been shown in tissue samples to reduce blood flow and forms the basis for the claims made by Uncircle, a product sold by Estee Lauder, and others in the physician dispensing market.

      Some of the older formulations for reducing undereye circles contain the astringent witch hazel. Witch hazel is thought to also change blood flow kinetics around the eyes by increasing venous tone. There is little data to substantiate this effect, however topical witch hazel in the undereye area does create the sensation of tightening after application.

      Probably the most successful temporary method of reducing undereye fullness and circles is the use of topical optical agents that change light reflection from the tissue beneath the eyes. The most easily cosmetically correctable cause of undereye darkness is by reduction of shadows. Shadows are created around the eye area by a prominent superior orbital rim, a recessed eye, or increased pigmentation. All of these conditions decrease the amount of light that is reflected from the undereye skin back to the observer’s eye. If the amount of reflected light could be increased, the darkness under the eyes could be reduced. This is best accomplished by topical products containing light reflective pigments. Since pigments can now be ground into very small particles, a combination of pigments and light reflectors can be created to lighten the undereye tissues via camouflage and increase light reflection. This is how most line reducing undereye moisturizers work.

      Finally, the effect of the moisturizer on altering the air/skin interface is also important. If the light can be prevented from penetrating through the skin down to the vasculature, the purplish/gray appearance of the skin can be improved. A variety of emollients and oily substances can be combined to improve skin feel and alter light penetration. Most of these undereye moisturizers are based on dimethicone with the addition of film forming agents, such as proteins. The proteins that may be added include some of the engineered fragments of collagen that have been shown in Petri dish work to increase collagen synthesis by down-regulating collagenase. In most commercial preparations, the concentration of these expensive proteins is minimal. Their optical and moisturizing effects are probably more important than any cellular behavior modification that might occur.

      Lip Plumping Lipsticks

      The approval of new injectable fillers to enhance lip fullness has created tremendous interest in topical cosmetics to replicate this effect. Many of these lip plumpers advertise hyaluronic acid as the skin active ingredient. A new raw material has been developed in the cosmetic industry consisting of small hyaluronic acid spheres. These spheres expand when placed on the skin surface from an oily vehicle. They can absorb up to 25 times their weight in water and account for the lip plumping effect in some products. The spheres tend to collect in the folds of the lip and expand to create a more even surface for lipstick application. The effect is temporary until the spheres are removed. Other products contain a similar ingredient known as marine atelocollagen, which is formed into a sphere, but the atelocollagen can only absorb up to 10 times its weight in water.

      Most of the lip plumping cosmetics are rich in silicone technology to improve the shine and smoothness of the lips. Dimethicone is the main shine ingredient, but it must be combined with other silicones to stay in place. Stearyl dimethicone is an alkylmethylsiloxane that is a wax instead of an oil, which melts at body temperature to increase lip hydration. This can be combined with perfluornonyl dimethicone to increase the wear of the lip cosmetic and make the lips feel smooth.

      Age Defying Facial Foundations

      The last area for discussion is the realm of age defying facial foundations. I am not sure what age defying means, but I assume it is synonymous with anti-aging. These foundations minimize the appearance of fine lines and wrinkles again by modifying the amount of light returned to the eye of the observer. Wrinkles appear dark not because they contain more pigment than the rest of the skin, but rather the fold is farther away from the eye than the surrounding skin. The trick is to get enough light reflection into the wrinkle to increase light reflection and minimize the dark appearance. Age defying facial foundations rely on the same sophisticated pigment technology as the undereye circle products previously discussed. The evenness of the film and the distribution of the pigments over the skin surface account for the temporary appearance improvement.


      The realm of line erasing, skin plumping and age defying cosmetics is similar to watching a magic show. Everyone sees the dove disappear, knows that it was an illusion, and wants to find out how the magician accomplished the feat. The new developments in colored cosmetics are much the same. The lips do appear slightly plumper, shinier, and more attractive, but how does the cosmetic create this illusion. This article has served to tell a few of cosmetic magician’s tricks. Even though we realize the final result is cosmetic illusion, there is no doubt that the magic sells.