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You’ve Come a Long Way Baby: A History of Cosmetic Lead Toxicity JOSEPH A. WITKOWSKI, MD LAWRENCE CHARLES PARISH, MD

Occasionally, we get caught up with being abso-lutely up-to-date, as in “Thoroughly ModernMillie,” something that might be appropriate as we begin the new millennium. We tend to believe that even “lookin’ good” is an invention of recent vin- tage, and yet men and women of ancient civilizations were concerned about their appearance. There were not halogen lighted vanities, but once the mirror was dis- covered, people were able to improve their appearances with greater ease.

Cosmetics have played a large role in satisfying this preoccupation with appearance. Creams, powders, and pastes were used to hide defects, enhance beauty, dec- orate as a creative expression, preserve beauty, and combat the ravages of time and exposure. Gmishes of all sorts could be employed to restore beauty and im- prove self-image. They could become marks of marital and social status, seniority, achievements, and even religious persuasion.

Organic and inorganic cosmetics were widely used in many civilizations, there being documentation of their use as early as the preclassical period of the east- ern Mediterranean region. Many elements were com- pounded: lead, mercury, antimony, bismuth, arsenic, and zinc, just to name a few. Unfortunately, the quest for beauty also led to cutaneous and even systemic toxicity.

The Element Lead

Lead was one of the first metals to be mined and smelted. Its uses can be documented for over 8,000 years, with archeological artifacts to provide confirma- tion. Lead is mentioned in ancient histories and in the Book of Ezekiel 22:18, 27:12. Lead beads dating to 6,500 BCE have been found in what is modern Turkey, while the Egyptians of the same period used lead to glaze pottery, make solder, and cast ornamental objects.1

Lead is found in nature mostly in combinations such as galena (PbS), anglesite (PbSO4), or cerussite, which is native lead carbonate (PbCO3). The most common min- eral is galena, a dark gray form of lead that often contains antimony along with other metals, although white lead and red lead are the oldest metallurgical forms of this metal.

White lead is basic lead carbonate (2PbCO3 z Pb (OH)2). White lead is formed by placing lead sheets in earthen pots that contain a weak solution of acetic acid. The pots are then buried in spent tanbark, which fer- ments, producing heat and carbon dioxide. The heat vaporizes the acetic acid. This vapor and the carbon dioxide act on the lead to form white lead powder.2 Red lead or (Pb3O4) is prepared by heating lead monoxide or litharge (PbO) in the presence of air. Litharge is produced by air oxidation of lead. Red lead is also found in its natural state in certain mineral ores. An- other form of lead which was first used by the Greeks is lead acetate or ceruse [Pb (C2H3O2) 2]. Dissolving li- tharge in strong acetic acid makes this.3

Lead Poisoning

Lead poisoning, also referred to as plumbism or saturn- ism, results from the gradual accumulation of lead in the body due to repeated exposure to lead-containing compounds. Symptoms and signs in adults may de- velop gradually or occur suddenly after chronic expo- sure. The poison affects the entire body, especially the neuromuscular system, the gastrointestinal tract, and the hematopoetic tissue. The victim usually becomes pallid, moody, and irritable, often complaining of in- somnia and being plagued by a metallic taste. A pur- plish line (the lead line) or dots may be seen on the gingival margin. Loss of appetite, headache, severe ab- dominal pain, or lead colic, and constipation are com- mon. The abdominal muscles become rigid and tender. All of this may be accompanied by anemia with baso- philic stippling of the erythrocytes.

Muscle weakness and easy fatigue occur before pa- ralysis and may be the only signs. The weakness occa- sionally becomes evident only after extended muscle activity. The muscle groups involved are usually the most active ones, such as the extensors of the forearms, wrists, and fingers, resulting in wrist drop. (Worse yet,

From the Department of Dermatology, University of Pennsylvania School of Medicine Philadelphia, Pennsylvania, USA (JAW), and the De- partments of Dermatology and Cutaneous Biology, and the Jefferson Center for International Dermatology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA (LCP).

Address correspondence to Joseph A. Witkowski, MD, 3501 Ryan Ave- nue, Philadelphia, PA 19135 USA.

E-mail address: [email protected]

© 2001 by Elsevier Science Inc. All rights reserved. 0738-081X/01/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0738-081X(01)00196-1

lead encephalopathy and nephropathy may result in death.)4

Egypt and the Near East

The ancient Egyptians were fond of coloring their eye- lids. At first, they used malachite (a green ore of cop- per), and later galena. This latter cosmetic has been found in small linen or leather bags retrieved from Egyptian tombs. (ca. 3,000 BCE.) Inhabitants of Meso- potamia of about the same period also used galena to decorate their eyelids.5

Kohl, a prepared form of eye paint, was also an Egyptian cosmetic. It has been found in shells, hollow reeds, and vases; it was often wrapped in leaves. Some of the specimens of kohl had traces of antimony.6 Later, the Babylonians of about 2,000 BCE applied Egyptian kohl or parched antimony, called stibium from its re- semblence to soot, to make their eyes appear larger and more lustrous.7

Greco-Roman Period

The use of lead-based cosmetics is believed to have begun in Europe during the Archaic period. Archeolo- gists have discovered a small amount of powder deter- mined to be lead sulfate hydrate in a Mycenean tomb dated 1,350 –1,100 BCE, which would be equivalent to the Bronze Age in Greece. During this time, Greek women were the first to use white lead as a face cream to clear complexions of blemishes and to improve the color and texture of the skin. Later, in the Classic and Hellenistic period (700 –300 BCE), lead-based face masks became the custom.8 Excessive use of these lead cosmetics also became recognized as a health hazard and was ridiculed in writings of the time.9

The use of face masks spread from Greece to the other civilizations around the Mediterranean Sea.8 They were used to remove wrinkles and to tighten the skin. Pliny, in the first century CE, wrote that lead could be used for removal of scars, employed as a liniment, or added to plasters for the treatment of ulcers and afflic- tions of the eyes.1

The Romans used white lead, called cerussa, to whiten their faces, and red lead, known as minium, for rouge. Distilling fine shavings of lead over strong acids made Cerussa. Lead shavings have been postulated to be the byproducts of lead pipe manufacture, an impor- tant aspect of the aqueduct system. There was a signif- icant risk of poisoning from lead in cosmetics and water pipes. Marcus Vitrivius Pollio, a first century Roman architect and engineer, recommended that clay pipes rather than lead is used to transport water, having recorded the poor color of the workers in lead facto- ries.1

Cerussa was applied to the face with fingers or small brushes in a manner similar to the process of enameling

the face known in Greece 50 years prior. To illustrate the effect of white lead, Martial (40?–104? CE), the Roman satirist, wrote, “Blackberry hued Lycoris feels delight knowing that cerussa makes skin light.”10

The Greeks and Romans used a variety of animal, vegetable, and mineral substances to dye their hair. Of the minerals, lead became known as the necessary in- gredient. If not added directly to the organic mixture, lead could indirectly become part of the formula. One recipe specified that the organic substances and sour wine be allowed to decompose in a lead vessel, where acids could leach the lead from the container.10

Lead containers were used throughout the Roman Empire to store liquids, including wine, and eventually became known as a health hazard.8 Ovid (47 BCE–17? CE) wrote of the deleterious effect of dyes on the hair as well as poisoning caused by hair dyes.8 Marcellus Em- piricus, a physician of the fourth century CE, insisted that after application of one of his concoctions the head be wrapped in cloth until the hair dried. He also rec- ommended that the face be greased to prevent staining and that the mouth be kept full of oil to avoid blacken- ing of the teeth.10

Sixteenth Century

The use of cosmetics was again in vogue during the sixteenth century. White faces became fashionable.12 Even adolescent women painted their faces with ceruse, a mixture of white lead and vinegar. White lead was occasionally mixed with sublimate of mercury (HgCl2) to peel the skin, while an ointment of lead sulfate was used to remove freckles. The latter probably provided instant gratification with immediate skin peeling. Many women continued to use ceruse, although it was known that it could cause gastrointestinal symptoms and trem- bling.13

The high forehead, depicted on paintings of women of this era, is believed to have been caused by cosmetics. Excessive application of white lead paint to the hair- bearing skin is said to have caused the hair to fall out by the handful. Fashionable women emulate afflicted con- ferees by shaving and plucking their hair from the frontal hairline. Perhaps this was unnecessary because so few women had a full hairline due to the application of lead.12

Seventeenth and Eighteenth Centuries

Excessive use of cosmetics became common among the rich and powerful women. This would prove to be most unfortunate, as lead carbonate was the major compo- nent of a popular face powder. Bailey and Blew, the London perfumeries and purveyors to royalty, adver- tised a facial whitening lotion whose use made the face appear a highly coveted dead white.14

Diseases caused by lead cosmetics became well known among medical community and the consumers,

368 WITKOWSKI AND PARISH Clinics in Dermatology Y 2001;19:367–370

with reports of lead poisoning appearing in the news- papers. Marie Gunning, one of the beautiful and fa- mous Gunning sisters of Ireland, was partial to the white look. When she died in 1760, the press referred to the Countess of Coventry as “a victim of cosmetics.” Seven years later, Kitty Fisher, a famous actress and courtesan of Georgian England, was also killed by lead poisoning.13

The sophisticated American colonists were not spared this plight. The first face powders made in the colonies consisted of lead, arsenic salts, or bismuth. Imperial Royal Cream Wash Balls soap was most pop- ular, without the benefit of modern advertising. This cosmetic was composed of rice powder, orris, and of course, white lead. By 1735, it was held to be the most beneficial of all cosmetics.15

Nineteenth Century

The middle of the nineteenth century in Great Britain saw the end of cosmetic artifice. With the ascent of Queen Victoria to the throne in 1837, cosmetics fell into disfavor, first as a reaction against the licentiousness of the Regency period and later as part of the extended mourning for Prince Albert. The young queen had no interest in fashion, although she adored jewelry.14 White faces were now passé, so that among the genteel, rouge soon became the mark of the immoral or eccentric woman.12

The extravagant use of cosmetics, however, was re- born in the theater, as the nineteenth century wore on. Following the invention of the carbon arc lamp in 1846, actors and actresses required a heavier makeup to look their best on the stage.16 Tragedy would again be the conclusion. For example, the French actor Melingue succumbed to lead poisoning in 1875. By applying col- oring prepared with lead— often to excess— he could make up his face better and produce greater effects than by the use of ordinary cosmetics. He paid no attention to the cutaneous absorption of lead and so succumbed to leaded cosmetics.17

The purveyors of lead-based cosmetics were not im- mune to their effects. There was London’s Mme. Rachel, who sold a lead containing facial wash that caused a violent eruption wherever applied; she died from lead poisoning on April 26, 1878. Many thought she had a just comeuppance for making a dishonest fortune from her fraudulent beauty treatments.15

In America, the leaded white face again became fash- ionable in the post–Civil War period, when the nou- veau riche wanted to emulate their continental sisters.15 Lead oleate was the favorite cream.16 A heavy lead powder and enamel was used to produce extreme pal- lor, to cover deformities, and to remove defects such as moles, freckles, and tans.14 The incidence of lead palsy increased alarmingly.

In 1869, three cases of toxicity from the use of a

cosmetic called “Laird’s Bloom of Youth” was reported by Dr. L. A. Sayre of New York, who described three young women who had used one bottle of whiting lotion each month for 2 to 5 years. The lotion contained lead acetate and carbonate. They all suffered from fa- tigue, weight loss, gastrointestinal symptoms, and atro- phy and paralysis of the muscles of the fingers, hands, and forearms.18 In 1870 Dr. Chandler published a report for the Metropolitan Bureau of Health of New York on dangerous cosmetics, which included lotions, enamels, powders, and hair tonics. Lead was still present in hair dyes, also referred to as restorers, invigorates, and re- juvenators, as late as 1878.

In 1884 Dr. Tuttle wrote that being lead free did not make a cosmetic safe as it could still contain mercury. He called for the full disclosure of ingredients in cos- metics and at the same time, prohibitions on the sale of cosmetics containing dangerous metals.19 The Food, Drug, and Cosmetic Act in the United States would not become law until 1938.

Twentieth Century

The new century signaled many changes, not the least of which was the death of Queen Victoria in 1901. Make up was again being used, even if almost exclusively for theatrical purposes. The birth of the motion picture meant that cosmetic requirements had changed, once more. Helena Rubinstein created mascara for the silent star Theda Bara based on experiments with kohl. With heavy lidded eyes, bland white face, and carefully red- dened mouth, Miss Bara gave cinema audiences a new view of femininity.12 Actresses were the only women who knew anything of the art of cosmetics or who would dare to be seen in public wearing anything other than the lightest film of rice powder.13 Other women generally were hesitant about the use of cosmetics be- cause the danger was still present, perhaps with good reason, for another case of lead poisoning appeared in the literature, this time due to face enamel. In 1922 H. W. Woltman reported a fatal case due to the use of ceruse.20

Since the 1930s, white lead has not been present in American-made powders.21 The withdrawal of this toxic agent has been attributed to the influence of the American Medical Association on the cosmetic indus- try.11 Today, lead acetate is found only in progressive hair dyes. These dyes apparently can be used safely, as the lead exposure from them is insignificant.22

Conclusions

The manufacture of cosmetics has evolved greatly as the result of biomedical and technological advances during the past 50 years. While there is no longer a need for toxic substances in make up, not all cosmetics are safe. Serious injury from cosmetics, however, is a rare

Clinics in Dermatology Y 2001;19:367–370 COSMETIC LEAD TOXICITY 369

event, but contact dermatitis has become the most sig- nificant culprit.

Irritant and allergic reactions to skin peelers, preser- vatives, and fragrances do occur. Depilatories can pro- duce a burn if allowed to remain on the skin for too long. Hair straighteners can weaken the hair to the point at which it breaks. Liquid mascara can become contaminated with harmful bacteria, leading to infec- tion when the applicator is returned to the container.

Today’s major risk—the modern one, perhaps—from the use of cosmetics occurs when the the consumer applies a lipstick or an eyeliner while driving a motor vehicle. The vehicle hits a bump in the road, the driver scratches her eyeball, or worse yet, may have an acci- dent.

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