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Manicures, Miscarriages and Mayhem

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Since my medical school training, medicine as an art has expanded itself. Among its many facets has emerged the field of epigenetics -- or simply put, the science of how the environment impacts our core functioning as humans -- at the molecular level of things. I have spoken of this topic before, but recently it has really hit home, not only changing the way I approach obtaining medical information from patients and recommending subsequent care, but in my belief that this new paradigm has and will continue to influence and transform, globally, the manner in which medical care is rendered.

Let me explain...

Recently I went to my favorite place of peace and relaxation -- the spa -- to have my facial, massage, and mani-pedi. While blissfully relaxed in my reclining chair, I happened to read an article discussing the commonality of specific medical issues among nail salon workers. Cancers, pulmonary disorders, skin ailments, children born with neurodevelopmental delays, low birth weight babies and miscarriages plague women who ply their craft in making hands and feet look beautiful. Environmental exposure to nail glues, solvents, hardeners and polishes has had associations with poor health and disastrous reproductive outcomes faced by workers in this profession.

As a maternal fetal medicine specialist contending with those medical issues impacting the pregnant woman as well as the fetus she is carrying -- aka the maternal -- fetal dyad -- my antennae were raised. One of the skill sets in my profession is to evaluate patients DURING pregnancy as well as PRIOR to pregnancy, in the "preconception" period, particularly if she has issues with conception and/or multiple pregnancy losses.

So the research began...

There are apparently three major chemicals in nail products known as the "toxic trio" -- toluene, dibutyl phthalate (DBP) and formaldehyde, which with continuous exposure are deemed to pose an apparent serious threat to maternal and fetal well-being.

Toluene -- according to the Environmental Protection Agency (EPA), toluene is a clear colorless liquid commonly added to gasoline, needed to produce benzene, utilized as a solvent, used in paints, thinners and inks. When used in nail polish, it gives a nice smooth finish and helps everything to dry quicker. The highest concentrations of toluene usually occur in the indoor air from use of the product. The brain is the primary target, with fatigue, sleepiness, and headache being common symptoms with continued exposure; central nervous system depression and death occur with subjection to high concentrations.

Chronic inhalation can be damaging to eyes, lungs, and the heart, with irregular heartbeats occurring as a specific symptom. Human studies, although perhaps influenced by other chemical exposures, have noted an increased incidence of spontaneous abortions, facial/limb abnormalities and growth retardation in fetuses; developmental effects such as brain dysfunction and attention deficits are seen in the children of pregnant women exposed to high levels of toluene.

Dibutyl phthalate (DBP) -- DBP makes nail polish pliable and shiny. Exposure occurs via inhalation, skin absorption and food. As of this month in Australia, this chemical will be banned from cosmetic use, as it has been deemed as causing harm to the developing fetus and impairing fertility.

Formaldehyde -- Most of us associate formaldehyde for its use as a preservative during the embalming process -- flashback to medical school Anatomy Class 101. In nail polish, this chemical compound functions as a hardener and prevents nail polish from chipping. Exposure occurs via inhalation and skin contact. In 2011, the National Toxicology Program -- a subsidiary of the U.S. Department of Health and Human Services -- noted formaldehyde as a human carcinogen. In 2016, it will be banned from the cosmetic industry in Europe.

So with this information, three questions immediately come to mind:

How is the U.S. cosmetic industry being regulated?

It is astounding to know that of the thousands of beauty products utilized, the vast majority of them have never been reviewed by any governmental or publicly-accountable organization. The Federal Food, Drug and Cosmetic Act of 1938 dictates the regulation of the chemical ingredients in nail products -- but fast forward 75+ years and while much has changed in the cosmetic industry -- nothing has changed with this decree. The FDA doesn't provide any regulatory mandates for ingredients in cosmetics either, except for the addition of color additives. Finally, neither the 1938 law, nor the FDA provide for any testing to demonstrate the safety of ingredients in cosmetics.

How are health providers to contend with women with poor reproductive outcomes?

For those health providers now faced with providing preconception counseling and/or prenatal diagnoses, the informational foundation has to be expanded. No longer can an infectious, genetic, anatomic or underlying medical condition be SOLELY considered in searching for an underlying etiologic factor for whatever reproductive malady exists --NOW providers need have some degree of working knowledge of environmental toxins and their effects on the maternal fetal dyad. But guess what? This is applicable to ALL medical providers, not just us dealing with mommies and babies -- to the cardiologist dealing with irregular heart beats, to the lung doctor dealing with chronic lung disease, and particularly to the cancer specialists dealing with some rare malignancy. Curriculum in medical schools, fellowships, and public health organizations will have to include epigenetics as a solid consideration in training those medical soldiers who are bidden to stamp out disease and pestilence and provide good patient care. Questions now have to be asked as to what is in the environment, what is the exposure, and how is this impacting the health -- reproductive and otherwise -- of the patient sitting in front of you.

At what price, beauty?

Well, my advice? Look at the ingredients. There are a number of websites, such as safecosmetics.org, which can advise as to which beauty products are deemed "safe." When getting that pretty mani-pedi, sit in a well-ventilated space, bring your own polish, and consider whether you really want those acrylic nail extensions.

Lastly, and finally, take a look back to yesteryear, when your grandmother was getting ready for a night out on the town -- hot water soaks for hands and feet, nail clippers, pumice stones, emery boards and a nail buffer worked well. It worked just fine for Nana -- AND might work just fine for you too.