Medically reviewed by Stefan Kuprowsky, ND
Isn’t it ironic that so many topical products your patients use every day for bodycare and cleansing aren’t “clean” in composition? Many contain the pernicious “Ps” — parabens and phthalates — which are highly regulated in the EU because research points toward negative health effects particularly from repeated, long-term exposure. And it is the cumulative effect of this exposure that has been shown through multiple studies to be cause for concern.
As a health professional, you may recommend topical products for your patients to help them achieve relief from pain, pruritis or other skin conditions. Ensure that part of your protocol for such patients is to recommend topical products that do not contain potentially unhealthy ingredients.
According to EWG.org, parabens are one of the most common preservatives used in cosmetic products. They are used in a wide variety of high-water-content products including shampoos, lotions, deodorants, scrubs and eye makeup because their antimicrobial abilities are highly effective against fungi and gram-positive bacteria. Parabens are listed specifically as methylparaben, propylparaben, isopropylparaben, isobutylparaben, butylparaben, and sodium butylparaben.
The non-profit Campaign for Safe Cosmetics reported, “parabens are known to disrupt hormone function, an effect that is linked to increased risk of breast cancer and reproductive toxicity.” Parabens bind to estrogen receptors on cells, causing estrogen influx, which can in turn accelerate breast cell division, leading to potential tumor growth.
Parabens are believed to act as an endocrine disruptor and stimulate estradiol activity. Paraben use has been implicated as potential causative factor in breast and skin cancers, as well as lowered viable sperm count.1 In breast tissue samples, researchers found that parabens have been found in 99% of samples, and that long-term exposure (more than 20 weeks) can lead to increased migratory and invasive activity of breast cancer cells, linked to metastatic activity.2
In a human study researchers were able to correlate reduced fertility in women with propylparabens as measured in urinary excretion.3 Another human study also associated butylparaben and total urinary paraben levels with decreased fertility, as indicated by decreased menstrual cycle length.4 Pregnancy too can be affected by paraben exposure. In one study, researchers found that butylparaben levels in the mother’s urine and levels in cord blood were associated with increased odds of pre-term birth and decreased birth weight.5
In a test undertaken by the Environmental Working Group, propylparaben was detected in 2,694 products with a high Skin Deep score of 7. Butylparaben was next highest in products, found in 586 tested, also with a high score of 7.
Parabens are, unfortunately, commonly detected in most people, as they are commonly found in popular products in the US and tend to accumulate in fat tissue over time. The CDC’s National Biomonitoring Program identified propylparaben in more than 92 percent of Americans tested and butylparaben in about 50 percent of those tested.
On a positive note, paraben levels in the body can decrease once the use of products with parabens has stopped. The 2016 HERMOSA intervention study of 100 girls found that after three days of using paraben-free products, propylparaben levels in urine dropped by approximately 45 percent.6
Another common family of additives found in cosmetics, hair and skin care products is phthalates. According to SafeCosmetics.org, cosmetic manufacturers may rely on phthalates as stabilizers and solvents. Hair sprays that tout no stiffness may contain dimethylphthalate, while some nail polishes contain dibutylphthlate to reduce cracking, and fragrances may have diethylphthalate as a fixative and solvent. Diethylphthalate is the most common phthalate used in cosmetics.
Similar to parabens, exposure to phthalates is implicated in endocrine disruption. One review asserted that in all studies analyzed, “exposure to phthalates adversely affected the level of reproductive hormones (luteinizing hormone, free testosterone, sex hormone-binding globulin), anogenital distance and thyroid function.”7
Research also has shown that phthalate exposure may increase risk of developing breast cancer,8 as well as stimulating early puberty onset in girls9 and abnormalities in male offspring.10
While some research links phthalate exposure to infertility in women and men,11 one meta-analysis found evidence that phthalates can reduce semen quality.12
Sulfates deserve a mention as they are also commonly used in many cleansers. Sulfates are surfactants and detergents used as cleansers (face, body and hair products). The most common are sodium lauryl sulfate, sodium laureth sulfate, sodium myreth sulfate and ammonium lauryl sulfate. Sulfates are also included in household cleaning products as they help create a lather that claws onto grit, dirt and oils for removal.
Unlike the pernicious Ps, sulfates are not inherently dangerous to health but for those who have sensitive skin or skin conditions such as dermatitis, psoriasis and eczema, it’s worth avoiding products containing them.
If you suspect patients may be experiencing symptoms from endocrine dysfunction, or skin irritations, it may be prudent to review the topical products they use daily.
Choose products for your patients carefully, and coach them to avoid phthalates, parabens and sulfates in products they select, from cosmetics and a range of personal care products to household cleaners. While individual products may contain limited amounts of parabens within safe limits set by the U.S. Food & Drug Administration (FDA), cumulative exposure to these chemicals from repeated use of multiple products could be contributing to a wide range of health problems.
- Chen et al. Toxicol Appl Pharmacol 2007 Jun 15;221(3):278-84
- Darbre, Harvey J Appl Toxicol 2014 34 (9): 925-938
- Smith et al. Environ Health Perspect 2013 121(11-12):1299-305.
- Nishihama et al. Reprod Toxicol 2016 Aug;63:107-13
- Geer, et al. Environ. Health Perspect. #P1-299
- Harley et al. Environ Health Perspect. 2016 Oct;124(10):1600-1607
- Jurewicz, Hanke, Int J Occup Med Envrion Health 2011 Jun;24(2):115-41
- Hsieh et al. FASEB 2012 Feb;26(2):778-787
- Harley et al. Human Reproduction 2019 Jan;34(1): 109–117
- Swan et al. Environ Health Perspect 2005 Aug;113(8):1056-1061
- Tranfo et al. Toxicol Letters 2012 Aug;213(1):15-20
- Cai et al. Environ Res 2015 Oct;142:486-494
*These statements have not been evaluated by the Food and Drug Administration. Our products are not intended to diagnose, treat, cure or prevent any disease.