Hair dyes and bladder cancer: an update

Safety assessment of personal care products/cosmetics and their ingredients

We attempt to review the safety assessment of personal care products (PCP) and ingredients that are representative and pose complex safety issues. PCP are generally applied to human skin and mainly produce local exposure, although skin penetration or use in the oral cavity, on the face, lips, eyes and mucosa may also produce human systemic exposure. In the EU, US and Japan, the safety of PCP is regulated under cosmetic and/or drug regulations. Oxidative hair dyes contain arylamines, the most chemically reactive ingredients of PCP. Although arylamines have an allergic potential, taking into account the high number of consumers exposed, the incidence and prevalence of hair dye allergy appears to be low and stable. A recent (2001) epidemiology study suggested an association of oxidative hair dye use and increased bladder cancer risk in consumers, although this was not confirmed by subsequent or previous epidemiologic investigations. The results of genetic toxicity, carcinogenicity and reproductive toxicity studies suggest that modern hair dyes and their ingredients pose no genotoxic, carcinogenic or reproductive risk. Recent reports suggest that arylamines contained in oxidative hair dyes are N-acetylated in human or mammalian skin resulting in systemic exposure to traces of detoxified, i.e. non-genotoxic, metabolites, whereas human hepatocytes were unable to transform hair dye arylamines to potentially carcinogenic metabolites. An expert panel of the International Agency on Research of Cancer (IARC) concluded that there is no evidence for a causal association of hair dye exposure with an elevated cancer risk in consumers. Ultraviolet filters have important benefits by protecting the consumer against adverse effects of UV radiation; these substances undergo a stringent safety evaluation under current international regulations prior to their marketing. Concerns were also raised about the safety of solid nanoparticles in PCP, mainly TiO(2) and ZnO in sunscreens. However, current evidence suggests that these particles are non-toxic, do not penetrate into or through normal or compromised human skin and, therefore, pose no risk to human health. The increasing use of natural plant ingredients in personal care products raised new safety issues that require novel approaches to their safety evaluation similar to those of plant-derived food ingredients. For example, the Threshold of Toxicological Concern (TTC) is a promising tool to assess the safety of substances present at trace levels as well as minor ingredients of plant-derived substances. The potential human systemic exposure to PCP ingredients is increasingly estimated on the basis of in vitro skin penetration data. However, new evidence suggests that the in vitro test may overestimate human systemic exposure to PCP ingredients due to the absence of metabolism in cadaver skin or misclassification of skin residues that, in vivo, remain in the stratum corneum or hair follicle openings, i.e. outside the living skin. Overall, today's safety assessment of PCP and their ingredients is not only based on science, but also on their respective regulatory status as well as other issues, such as the ethics of animal testing. Nevertheless, the record shows that today's PCP are safe and offer multiple benefits to quality of life and health of the consumer. In the interest of all stakeholders, consumers, regulatory bodies and producers, there is an urgent need for an international harmonization on the status and safety requirements of these products and their ingredients.

The debate on carcinogenicity of permanent hair dyes: new insights

Oxidative (permanent) hair dyes contain one or several "primary intermediates" (e.g., p-phenylenediamines, p-aminophenols) and "couplers" (e.g., m-aminophenols, m-hydroxyphenols). In the presence of peroxide, the primary intermediate(s) and the coupler(s) undergo a chemical reaction to form colored oligomers. In the 1970s a number of aromatic amines used in oxidative hair dyes were identified as mutagenic and/or carcinogenic in rodents after lifetime oral administration. In response, regulatory action was taken, and some hair dye ingredients were banned in the European Union. Although recent results suggest that the main "primary intermediate" of oxidative hair dyes, p-phenylenediamine, has a weak genotoxic potential in vitro, it was not mutagenic in a mixture with nonmutagenic couplers, if tested under conditions comparable to those of practical use. Under conditions of use of permanent hair dyes, between 0.1 and 0.5% of the applied p-phenylenediamine may be absorbed through the skin. Acetylation in the skin is a key metabolic step for the primary intermediates p-phenylenediamine and p-aminophenol. Because of the involvement of aromatic amines, the discussion on the carcinogenicity of hair dyes in humans has been focused on urothelial cancer. Numerous epidemiological studies have investigated the risk of bladder cancer associated with the profession as a hairdresser, as well as the risk to consumers of hair dyes. Although some earlier studies suggested an overrepresentation of bladder cancer in male hairdressers, the majority of modern studies do not show an increase in relevant bladder cancer risk for professional or personal use of oxidative hair dyes. Today, there seems to be no relevant bladder cancer risk from the use of oxidative hair dyes. Such a conclusion can be derived from new toxicokinetic and metabolism investigations and is in general accordance with current epidemiological data. Human urothelial cancers, chemically induced by aromatic amines, have typical latency times often longer than 20 years. Since earlier exposures could have an impact decades later, the possibility of bladder cancer in hairdressers having intensively worked with permanent hair dyes during earlier decades (prior to the 1980s) should be taken into account.

Personal permanent hair dye use is not associated with bladder cancer risk: evidence from a case-control study

Whether personal hair dye use is associated with an increased bladder cancer risk has been controversial and there are limited available data addressing this issue. We used a large case-control study of 712 incident bladder cancer cases and 712 age-, gender-, and ethnicity-matched controls to evaluate this association. After adjusting for confounding variables, the use of permanent hair dye was not associated with bladder cancer risk in all subjects [odds ratio (OR), 0.81; 95% confidence interval (95% CI), 0.50-1.30], in women (OR, 0.90; 95% CI, 0.41-1.96), or in men (OR, 0.68; 95% CI, 0.36-1.29). The lack of association was not modified by duration of use, frequency of use, lifetime use, age at first use, or color of use in subsequent stratified analyses. Our data do not support personal hair dye use as an important risk factor for bladder cancer.

Mechanisms of disease: The epidemiology of bladder cancer

Mortality from bladder cancer has shown downward trends over the last 2 decades in several western European countries (albeit 10-15 years later than similar trends in the US), but is still increasing in some eastern European countries. Tobacco smoking and occupational exposure to aromatic amines are the two major established environmental risk factors for bladder cancer. Controlling exposure to these factors has been an important contributor to the reduction in bladder cancer mortality, particularly among men. Diet could influence bladder carcinogenesis, as many compounds contained in foods--and their metabolites--are excreted through the urinary tract. Fruit and vegetable consumption was inversely related with bladder cancer in many studies, but no consistent association has emerged between intake of related micronutrients and reduced risk of bladder cancer. Other widely investigated lifestyle habits are probably not associated with risk of developing bladder cancer (e.g. coffee consumption, artificial sweetener use, hair dyes) or are difficult to assess (e.g. fluid intake). Infections and stones in the urinary tract might cause chronic irritation of the bladder epithelium, and thus increase bladder cancer risk. First-degree relatives of bladder cancer patients have a 50-100% increased relative risk of developing the disease, a risk that could be even higher when the proband is diagnosed at an early age.

Toxicity and human health risk of hair dyes

Hair dyes and their ingredients have moderate to low acute toxicity. Human poisoning accidents are rare and have only been reported following oral ingestion. Contact sensitisation to hair dyes has been a safety issue, mainly as a consequence of unprotected professional exposure. Although the use of hair dyes has dramatically increased in industrialised countries during the last decades, the prevalence of sensitisation to hair dyes in the general and professional populations has stabilised or declined. In vitro genotoxicity tests on hair dye ingredients frequently had positive results, although their correlation with in vivo carcinogenicity for the chemical class of oxidative hair dye ingredients (aromatic amines) is uncertain. Positive in vivo genotoxicity results on hair dyes are rare. Studies in man found no evidence of genotoxic effects of hair dyes or their ingredients. On the basis of mechanistic studies, some in vivo positive hair dye ingredients (p-aminophenol, Lawsone) have been shown to pose no or negligible risk to human health. Although a recent case-control epidemiology study suggested an association of hair dye use and bladder cancer, a number of other studies, including prospective investigations on large populations, found no or negative correlations for bladder or other cancers. Although in vivo topical carcinogenicity studies on hair dye ingredients or commercial formulations yielded no evidence for systemic toxicity or carcinogenicity, oral carcinogenicity studies on hair dye ingredients at oral doses up to the maximum tolerated dose (MTD) suggested that some ingredients are carcinogenic in rodents. Human systemic exposure to various (14)C-labelled oxidative hair dyes under conditions of use was below 1.0% of the amount applied. Conservative risk assessments suggested no or negligible cancer risk, including for ingredients that were found to be positive in oral carcinogenicity studies. The results of reproductive toxicity studies and epidemiological investigations suggested that hair dyes and their ingredients pose no risk of adverse reproductive effects. In conclusion, the weight of evidence suggests that consumer or professional exposure to hair dyes poses no carcinogenic or other human health risks.