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Hussein et al set out to ascertain the permeation of methyl, ethyl, propyl, and butyl paraben through the epidermal and dermal layers as well as accumulation in the skin layers and/or passage to other bodily tissues They found that the capacity of the various parabens to penetrate the skin was based on their relative lipophilicity with the more lipophilic, the less they were likely to penetrate or cross skin layers12 Butyl paraben is the most lipophilic of the four, followed by propyl, ethyl, and MP The most lipophilic paraben, butyl paraben, displayed comparatively weak passage through the skin, and has been shown elsewhere to have the potential for accumulating in the skin, particularly after multiple or frequent applications28 Nicotinamide, the biologically active amide of vitamin B3, is a hydrophilic molecule used as an active ingredient in cosmetic formulations for its moisturizing and depigmenting activity (see 33) In a recent study, it has also been shown to have the capacity to influence the transdermal permeation of
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methyl, ethyl, propyl, and butyl paraben Specifically, nictotinamide was found to promote the dissolution of parabens in solutions and gels and lower parabens partitioning in the oily phase thus ensuring an effective water-phase concentration in emulsion Investigators concluded that nicotinamide interacts with parabens by ultimately decreasing transdermal penetration, thereby diminishing the risk or potential for toxicity29 Interestingly, Lee et al have noted the dearth of studies evaluating the effects of a combination of preservatives in cosmetic formulations even though such products more often include a mixture of preservatives rather than a single preservative In response, they set out to evaluate the side effects of cosmetic preservatives alone or in combination as product ingredients and to assess objective and subjective sensory skin irritation (representing symptoms such as burning, stinging, and itching absent visual inflammation) The researchers found no significant differences among MP, ethyl paraben, propyl paraben, butyl paraben, phenoxyethanol, and chlorphenesin in objective skin irritation potential at the minimal inhibitory concentration However, chlorphenesin was found to exhibit greater potential in subjective irritation They also found that formulation type influenced sensory irritation and that the combination of phenoxyethanol and chlorphenesin significantly increased irritation30 It is worth noting that in a review of the major classes of preservatives as well as newer agents such as Euxyl K 400 and isopropynyl butylcarbamate, Sasseville concludes that while an ideal preservative, effective without potential for provoking irritancy or sensitivity, has not yet been identified, the parabens, which have been used for three-quarters of a century, continue to be the most frequently used preservatives while inducing sensitivity less often than newer biocides1
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In recent years, some concerns have been raised regarding possible links between some cosmetic products and breast cancer incidence In particular, an estrogenic potential has been reported in association with parabens contained in underarm deodorant, given their frequency of use and proximate location to the human breast and the identification of parabens in breast cancer tissue It is not uncommon for patients to bring questions to a physician based on main-
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stream news reports on medical issues The initial report in 2002 and its reverberating effects in the literature reached public awareness and have prompted some lingering concerns regarding the risks of common skin care product ingredients Even if patients are not broaching such issues, it is important to be prepared to inform them that nearly all skin care and cosmetic products contain preservatives While these ingredients are generally regarded as safe, certain risks are associated with their use In particular, some individuals may be found to be allergic to certain compounds Damaged or wounded skin may be especially susceptible to some chemical preservatives In addition, the effects from the chronic use of some products may not be fully understood This notion could be a pivotal point in the context of recommending daily use of certain products such as sunscreens It is within this context that the dermatologist should be familiar with preservatives in general and the benefits and risks of the most common preservatives in particular Products containing parabens should be avoided by most people who know they are allergic to parabens, which can be determined by patch testing There are no convincing data that parabens cause harm to those not allergic to these compounds Because of some sensationalistic reporting in recent years, though, many are choosing to avoid products containing this class of preservative ingredients Again, for those not allergic to parabens, there are no scientifically established reasons to avoid the plethora of cosmetic and skin care products that contain these preservatives Much more research is necessary to determine if what appears to be a relatively weak level of estrogenicity in parabens can promote carcinogenesis Patients can be directed to health food stores, chains such as Whole Foods, or Internet resources for products that are touted for excluding parabens or other preservatives if they express such interest It is important to advise them that the efficacy and safety of such products may be questionable and surely not established through randomized, double-blind clinical trials
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