Risks of Skin, Hair, and Nail Supplements
Keywords:
dietary supplements, toxicity, adverse effects, diet, nutritionAbstract
Skin, hair, and nail supplements, sometimes referred to as “beauty supplements” or “ingestible skin care”, are a large and growing industry. These products may contain vitamins and minerals, sometimes in very high doses. They may also contain herbs, hormones, microbes, or animal derivatives such as fish oils and collagen powders.
Dietary supplements are regulated as foods, not drugs, by the U.S. Food and Drug Administration. Therefore, manufacturers do not need to provide any proof of safety, efficacy, or quality prior to sale. This is of serious concern, as many adverse effects due to supplement components have been reported.
The potential risks cover multiple categories. These include acute toxicities such as choking, as well as chronic toxicities, such as increased risk of diabetes. Teratogenicity and interaction with drugs and laboratory testing have been documented in research studies. Other risks include potentially increased risk of cancer with long-term use, allergic reactions, and others.
It is vital that physicians educate their patients on these risks. As no post-marketing surveillance programs are required for supplements, our understanding of supplement risks is incomplete. Physicians should be wary of these risks and encourage further research and regulation.
References
Bailey RL, Gahche JJ, Miller PE, Thomas PR, Dwyer JT. Why US adults use dietary supplements. JAMA Intern Med. 2013;173(5):355-361. DOI: 10.1001/jamainternmed.2013.2299. PMID: 23381623.
Chen F, Du M, Blumberg JB, et al. Association among dietary supplement use, nutrient intake, and mortality among U.S. adults: a cohort study. Ann Intern Med. 2019;170(9):604-613. PMID: 30959527.
Kantor ED, Rehm CD, Du M, White E, Giovannucci EL. Trends in dietary supplement use among US adults from 1999-2012. JAMA. 2016;316(14):1464-1474. DOI: 10.1001/jama.2016.14403. PMID: 27727382.
Bailey RL, Gahche JJ, Lentino CV, et al. Dietary supplement use in the United States, 2003-2006. J Nutr. 2011;141(2):261-266. DOI: 10.3945/jn.110.133025. PMID: 21178089.
Katta R, Huang S. Skin, Hair and nail supplements: an evidence-based approach. Skin Therapy Lett. 2019;24(5):7-13. PMID: 31584785.
U.S. Food and Drug Administration. Dietary Supplement Labeling Guide: Chapter IV. Nutrition Labeling. April 2005. Accessed March 27, 2020. http://www.fda.gov/food/dietary-supplements-guidance-documents-regulatory-information/dietary-supplement-labeling-guide-chapter-iv-nutrition-labeling
U.S. Food and Drug Administration. CFR - Code of Federal Regulations Title 21. Updated April 1, 2019. Accessed March 27, 2020. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?fr=101.9
U.S. Food and Drug Administration. Questions and Answers on Dietary Supplements. Accessed April 20, 2020. https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements
U.S. Food and Drug Administration. Small Entity Compliance Guide: Label Warning Statements for Iron-Containing Supplements and Drugs. October 2003. Accessed April 19, 2020. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/small-entity-compliance-guide-label-warning-statements-iron-containing-supplements-and-drugs
Geller AI, Shehab N, Weidle NJ, et al. Emergency department visits for adverse events related to dietary supplements. N Engl J Med. 2015;373(16):1531-1540. DOI: 10.1056/NEJMsa1504267. .
Punzalan C, Budnitz DS, Chirtel SJ, et al. Swallowing problems and dietary supplements: data from U.S. Food and Drug Administration Adverse Event Reports, 2006–2015. Ann Intern Med. 2019;171(10):771. DOI: 10.7326/M19-0947. PMID: 31426091..
Lui MFG, Chow HKD, Wong WMK, Tsang WNW. Melatonin affects postural control in community-dwelling older adults while dual tasking: a randomized observation study. J Aging Phys Act. 2018:1-6. DOI: 10.1123/japa.2017-0312. PMID: 29809094.
Knight J, Madduma-Liyanage K, Mobley JA, Assimos DG, Holmes RP. Ascorbic acid intake and oxalate synthesis. Urolithiasis. 2016;44:289–97. DOI: 10.1007/s00240-016-0868-7. PMID: 27002809.
Baxmann AC, de O.G. Mendonça C, Heilberg IP. Effect of vitamin C supplements on urinary oxalate and pH in calcium stone-forming patients. Kidney Int. 2003;63(3):1066-1071. DOI: 10.1046/j.1523-1755.2003.00815.x. PMID: 12631089.
Rees DC, Kelsey H, Richards JD. Acute haemolysis induced by high dose ascorbic acid in glucose-6-phosphate dehydrogenase deficiency. BMJ. 1993;306:841-842. DOI: 10.1136/bmj.306.6881.841. PMID: 8490379.
Jansen T, Romiti R, Kreuter A, Altmeyer P. Rosacea fulminans triggered by high-dose vitamins B6 and B12. J Eur Acad Dermatol Venerol. 2001;15(5):484-485. DOI: 10.1046/j.1468-3083.2001.00308.x.
Guo EL, Katta R. Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatol Pract Concept. 2017;7(1):1–10. DOI: 10.5826/dpc.0701a01. PMID: 28243487.
Coates TD, Carson S, Wood JC, Berdoukas V. Management of iron overload in hemoglobinopathies: what is the appropriate target iron level? Ann N Y Acad Sci. 2016;1368:95-106. DOI: 10.1111/nyas.13060. PMID: 27186942.
Wooltorton E. Too much of a good thing? Toxic effects of vitamin and mineral supplements. CMAJ. 2003;169(1):47-48. PMID: 12847042.
Nutrafol Core for Women | Nutrafol. Accessed March 20, 2020. https://nutrafol.com/nutrafol-core-for-women
Rayman MP, Winther KH, Pastor-Barriuso R, et al. Effect of long-term selenium supplementation on mortality: Results from a multiple-dose, randomised controlled trial. Free Radic Biol Med. 2018;127:46-54. DOI: 10.1016/j.freeradbiomed.2018.02.015. PMID: 29454039.
Bleys J, Navas-Acien A, Guallar E. Serum selenium and diabetes in U.S. adults. Diabetes Care. 2007;30(4):829-834. DOI: 10.2337/dc06-1726. PMID: 17392543.
Bleys J, Navas-Acien A, Stranges S, et al. Serum selenium and serum lipids in US adults. Am J Clin Nutr. 2008;88(2):416-423. DOI: 10.1093/ajcn/88.2.416. PMID: 18689378.
Stranges S, Laclaustra M, Ji C, et al. Higher selenium status is associated with adverse blood lipid profile in British adults. J Nutr. 2010;140:81-87. DOI: 10.3945/jn.109.111252. PMID: 19906812.
Stranges S, Marshall JR, Natarajan R, et al. Effects of long-term selenium supplementation on the incidence of type 2 diabetes: a randomized trial. Ann Intern Med. 2007;147:217. DOI: 10.7326/0003-4819-147-4-200708210-00175. PMID: 17620655.
Faghihi T, Radfar M, Barmal M, et al. A randomized, placebo-controlled trial of selenium supplementation in patients with type 2 diabetes: effects on glucose homeostasis, oxidative stress, and lipid profile. Am J Ther. 2014;21(6):491-495. DOI: 10.1097/MJT.0b013e318269175f. PMID: 23633679.
Nutrient Recommendations: Dietary Reference Intakes (DRI). n.d. Accessed April 19, 2020. https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx
Institute of Medicine (US) Subcommittee on Interpretation and Uses of Dietary Reference. Using the Tolerable Upper Intake Level for Nutrient Assessment of Groups. DRI Dietary Reference Intakes: Applications in Dietary Assessment. National Academies Press (US); 2000. https://www.ncbi.nlm.nih.gov/books/NBK222879/
Parekh PP, Khan AR, Torres MA, Kitto ME. Concentrations of selenium, barium, and radium in Brazil nuts. Journal of Food Composition and Analysis. 2008;21(4):332-335. DOI: 10.1016/j.jfca.2007.12.001.
Fugh-Berman A. Herb-drug interactions. Lancet. 2000;355:134-138. DOI: 10.1016/S0140-6736(99)06457-0. PMID: 10675182.
The FDA Warns that Biotin May Interfere with Lab Tests: FDA Safety Communication. FDA. November 28, 2017. Accessed April 16, 2020. https://www.fda.gov/medical-devices/safety-communications/fda-warns-biotin-may-interfere-lab-tests-fda-safety-communication
Li D, Radulescu A, Shrestha RT, et al. Association of biotin ingestion with performance of hormone and nonhormone assays in healthy adults. JAMA. 2017;318(12):1150-1160. DOI: 10.1001/jama.2017.13705. PMID: 28973622.
Williams GR, Cervinski MA, Nerenz RD. Assessment of biotin interference with qualitative point-of-care hCG test devices. Clin Biochem. 2018;53:168-170. DOI: 10.1016/j.clinbiochem.2018.01.018. PMID: 29395091].
Cheema P, El-Mefty O, Jazieh AR. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature. J Intern Med. 2001;250:167–9. DOI: 10.1046/j.1365-2796.2001.00851.x. PMID: 29395091.
Yeu E, Grostern R. Saw palmetto and intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2007;33(5):927-928. 10.1016/j.jcrs.2006.12.032. PMID: 17466877.
Villanueva S, González J. Coagulopathy induced by saw palmetto: a case report. Bol Asoc Med P R. 2009;101:48–50. PMID: 20120986.
Beckert BW, Concannon MJ, Henry SL, Smith DS, Puckett CL. The effect of herbal medicines on platelet function: an in vivo experiment and review of the literature. Plast Reconstr Surg. 2007;120(7):2044-2050. 10.1097/01.prs.0000295972.18570.0b. PMID: 18090773.
Appendix K. Prototype Focused Monograph: Review of Antiandrogenic Risks of Saw Palmetto Ingestion by Women. In: Dietary Supplements: A Framework for Evaluating Safety. Institute of Medicine (US) and National Research Council (US) Committee on the Framework for Evaluating the Safety of Dietary Supplements. National Academies Press; 2005. Accessed December 13, 2019. https://www.ncbi.nlm.nih.gov/books/NBK216069/
Veltri RW, Marks LS, Miller MC, et al. Saw palmetto alters nuclear measurements reflecting DNA content in men with symptomatic BPH: evidence for a possible molecular mechanism. Urology. 2002;60(4):617-622. DOI: 10.1016/S0090-4295(02)01838-1. PMID: 12385921.
Di Silverio F, Monti S, Sciarra A, et al. Effects of long-term treatment with Serenoa repens (Permixon®) on the concentrations and regional distribution of androgens and epidermal growth factor in benign prostatic hyperplasia. Prostate. 1998;37(2):77-83. DOI: 10.1002/(SICI)1097-0045(19981001)37:2<77::AID-PROS3>3.0.CO;2-I. PMID: 9759701.
Miller RK, Hendrickx AG, Mills JL, Hummler H, Wiegand U. Periconceptional vitamin A use: how much is teratogenic? Reprod Toxicol. 1998;12(1):75-88. DOI: 10.1016/S0890-6238(97)00102-0. PMID: 9431575.
Rothman KJ, Moore LL, Singer MR, et al. Teratogenicity of high vitamin A intake. N Engl J Med. 1995;333:1369-1173. DOI: 10.1056/NEJM199511233332101. PMID: 7477116.
Martínez-Frías ML, Salvador J. Epidemiological aspects of prenatal exposure to high doses of vitamin A in Spain. Eur J Epidemiol. 1990;6(2):118-123. DOI: 10.1007/BF00145783. PMID: 2361535.
Derma Drink. Accessed March 30, 2020. https://dermadrink.com/products/derma-drink
Yang X, Yu X, Fu H, Li L, Ren T. Different levels of prenatal zinc and selenium had different effects on neonatal neurobehavioral development. Neurotoxicology. 2013;37:35-39. DOI: 10.1016/j.neuro.2013.04.001. PMID: 23570748.
Kennaway DJ. Potential safety issues in the use of the hormone melatonin in paediatrics. J Paediatr Child Health. 2015;51(6):584-589. DOI: 10.1111/jpc.12840. PMID: 25643981.
Blumenthal KG, Wickner PG, Lau JJ, Zhou L. Stevens-Johnson syndrome and toxic epidermal necrolysis: A cross-sectional analysis of patients in an integrated allergy repository of a large health care system. J Allergy Clin Immunol Pract. 2015;3(2):277-280.e1. DOI: 10.1016/j.jaip.2014.10.002. PMID: 25609329.
Le T-M, Sanders CJG, van de Corput L, van Erpecum KJ, Röckmann H. Drug rash with eosinophilia and systemic symptoms caused by the dietary supplement diindolylmethane. J Allergy Clin Immunol Pract. 2016;4(1):175-176. DOI: 10.1016/j.jaip.2015.07.007. PMID: 26298826.
Witkowski JA, Parish LC. Dermatologic manifestations of complementary therapy. Skinmed. 2003;2(3):175-180. DOI: 10.1111/j.1540-9740.2003.02166.x. PMID: 14673295.
Andreozzi L, Giannetti A, Cipriani F, Caffarelli C, Mastrorilli C, Ricci G. Hypersensitivity reactions to food and drug additives: problem or myth? Acta Biomed. 2019;90(3-S):80-90. DOI: 10.23750/abm.v90i3-S.8168. PMID: 30830065.
Swerlick RA, Campbell CF. Medication dyes as a source of drug allergy. J Drugs Dermatol. 2013;12(1):99-102. PMID: 23377335.
Fujimoto W, Fukuda M, Yokooji T, Yamamoto T, Tanaka A, Matsuo H. Anaphylaxis provoked by ingestion of hydrolyzed fish collagen probably induced by epicutaneous sensitization. Allergol Int. 2016;65(4):474-476. DOI: 10.1016/j.alit.2016.03.012. PMID: 27569115.
Byers T, Perry G. Dietary carotenes, vitamin C, and vitamin E as protective antioxidants in human cancers. Annu Rev Nutr. 1992;12:139-159. DOI: 10.1146/annurev.nu.12.070192.001035. PMID: 1503801.
Martínez ME, Jacobs ET, Baron JA, Marshall JR, Byers T. Dietary supplements and cancer prevention: balancing potential benefits against proven harms. J Natl Cancer Inst. 2012;104:732–9. DOI: 10.1093/jnci/djs195. PMID: 22534785.
Katta R, Brown DN. Diet and skin cancer: The potential role of dietary antioxidants in nonmelanoma skin cancer prevention. J Skin Cancer. 2015;2015:8933149. DOI: 10.1155/2015/893149. PMID: 26583073.
Sander CS, Chang H, Hamm F, Elsner P, Thiele JJ. Role of oxidative stress and the antioxidant network in cutaneous carcinogenesis. Int J Dermatol. 2004;43(5):326-335. DOI: 10.1111/j.1365-4632.2004.02222.x. PMID: 15117361.
Hercberg S, Ezzedine K, Guinot C, et al. Antioxidant supplementation increases the risk of skin cancers in women but not in men. J Nutr. 2007;137(9):2098–2105. DOI: 10.1093/jn/137.9.2098. PMID: 17709449.
Vinceti M, Rothman KJ, Bergomi M, Borciani N, Serra L, Vivoli G. Excess melanoma incidence in a cohort exposed to high levels of environmental selenium. Cancer Epidemiol Biomarkers Prev. 1998;7(10):853-856. PMID: 9796628.
Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. 1996;334:1150-11155. DOI: 10.1056/NEJM199605023341802. PMID: 8602180.
Goodman GE, Thornquist MD, Balmes J, et al. The beta-carotene and retinol efficacy trial: incidence of lung cancer and cardiovascular disease mortality during 6-year follow-up after stopping β-carotene and retinol supplements. J Natl Cancer Inst. 2004;96(23):1743–1750. DOI: 10.1093/jnci/djh320. PMID: 15572756.
Brasky TM, White E, Chen C-L. Long-term, supplemental, one-carbon metabolism-related vitamin b use in relation to lung cancer risk in the Vitamins and Lifestyle (VITAL) Cohort. J Clin Oncol. 2017;35(30):3440-3448. DOI: 10.1200/JCO.2017.72.7735. PMID: 28829668.
Klein EA, Thompson IM, Tangen CM, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011;306(14):1549. DOI: 10.1001/jama.2011.1437. PMID: 21990298.
Wien TN, Pike E, Wisløff T, Staff A, Smeland S, Klemp M. Cancer risk with folic acid supplements: a systematic review and meta-analysis. BMJ Open. 2012;12(1):e000653. DOI: 10.1136/bmjopen-2011-000653. PMID: 22240654.
Nutrafol Ingredients. Accessed April 15, 2020. https://nutrafol.com/ingredients/.
FDA Finds Problems at 52% of Supplement Manufacturing Sites in U.S. and 42% Abroad. ConsumerLabCom. March 13, 2020. Accessed March 30, 2020. https://www.consumerlab.com/recall_detail.asp?recallid=14344&j=1310544&sfmc_sub=119745391&l=529_HTML&u=18020488&mid=7276525&jb=372&utm_medium=email&utm_source=exacttarget&utm_campaign=newsletter&utm_term=&utm_content=holy_basil_non_member_de_send
Dlugaszewska J, Ratajczak M, Kamińska D, Gajecka M. Are dietary supplements containing plant-derived ingredients safe microbiologically? Saudi Pharm J. 2019;27(2):240–245. DOI: 10.1016/j.jsps.2018.11.005. PMID: 30766436.
Fatal Gastrointestinal Mucormycosis in an Infant Following Use of Contaminated ABC Dophilus Powder From Solgar Inc. Fungal Diseases. CDC.gov. February 20, 2015. Accessed April 13, 2020. https://www.cdc.gov/fungal/outbreaks/rhizopus-investigation.html
Saper RB, Phillips RS, Sehgal A, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008;300:915–23. DOI: 10.1001/jama.300.8.915. PMID: 18728265.
ConsumerLab Reveals Best Collagen Supplements. ConsumerLabCom. October 4, 2019. Accessed April 13, 2020. https://www.consumerlab.com/news/consumerlab-tests-reveal-best-collagen-supplements/10-04-2019/
Tucker J, Fischer T, Upjohn L, Mazzera D, Kumar M. Unapproved pharmaceutical ingredients included in dietary supplements associated with US Food and Drug Administration warnings. JAMA Netw Open. 2018;1(6):e183337. DOI: 10.1001/jamanetworkopen.2018.3337. PMID: 30646238.
MacFarquhar JK, Broussard DL, Melstrom P, et al. Acute selenium toxicity associated with a dietary supplement. Arch Intern Med. 2010;170(3):256-261. DOI: 10.1001/archinternmed.2009.495. PMID: 20142570.
Araki T, Holick MF, Alfonso BD, et al. Vitamin D intoxication with severe hypercalcemia due to manufacturing and labeling errors of two dietary supplements made in the United States. J Clin Endocrinol Metab. 2011;96(12):3603-3608. DOI: 10.1210/jc.2011-1443. PMID: 21917864.
US Food and Drug Administration. Ventricular Arrhythmia (Torsades de Pointes) Occurring in Association with Terfenadine Use. April 6, 2016. Accessed April 13, 2020. https://www.fda.gov/drugs/drug-interactions-labeling/ventricular-arrhythmia-torsades-de-pointes-occurring-association-terfenadine-use
Anti-obesity drugs recalled from global market. The Lancet. 1997;350:867. DOI: 10.1016/S0140-6736(97)23038-2.
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