oa Kohl and surma eye cosmetics as significant sources of lead (Pb) exposure

Kohl (surma) is a traditional eye cosmetic used in the Middle East, India, Pakistan, and parts of Africa that often contains high levels of lead (Pb), a developmental neurotoxicant. Many researchers have called for stricter governmental regulations of kohl trade and quality control and improved public education regarding its hazards and some governments have adopted import controls and educational campaigns to alert users to the hazards of using Pb-­-containing kohl. However, users remain unaware of the hazards of kohl usage, and some authorities minimize its potential danger. In this review, we summarize available data from the peer-­-reviewed literature on prevalence and attitudes regarding kohl use, Pb content of kohl samples from many sources, potential routes of entry of Pb into the body from kohl, and epidemiologic evidence that kohl is a source of Pb exposure in infants and women. Chemical analyses show that kohl has a wide range of formulae, with some containing PbS as the principal ingredient and others based on carbon and often Pb-­-free. Ocular, dermal, or gastrointestinal routes of entry of Pb into the body from kohl had been insufficiently studied to rule any of them out. The preponderance of epidemiologic evidence supports the conclusion that Pb-­-based kohl is associated with increased PbB in women who use kohl and their children.