Expert Perspectives
TRICLOSAN: Protective or Disruptive?
What is Triclosan? Triclosan is a widely used antimicrobial agent that inhibits or stops the growth of bacteria and contamination. Because of its ability to destroy microbes, triclosan was once a common ingredient in many over-the-counter (OTC) antibacterial soaps and body washes. However, the potential effects of triclosan on humans have raised concerns about endocrine disruption, bioaccumulation (buildup in the body), and resistance to antibiotics/antibacterial products. What Contains Triclosan? It is used as a preservative in water-based formulations such as aftershave lotions, bath products, foot sprays, toothpastes, hair conditioners and make-up products. Toothpastes Containing Triclosan Triclosan is an antibacterial agent that can be added to toothpastes to reduce plaque and gingivitis. The use of triclosan as a preservative in toothpaste is safe at a concentration of 0.3% when used alone in both adults and children (0.5-18 years of age), but is unsafe when used in combination in children younger than 3 years of age. Soaps Containing Triclosan In 2013, the FDA required manufacturers of antibacterial soaps and body washes to provide evidence that their products were safe for long-term daily use. It also required that these products prove that they were more effective at preventing infections than products that did not contain triclosan. Researchers who examined data from many different studies found that people who used antibacterial soaps containing triclosan were just as likely to get sick as those who used regular soaps. Then the Food and Drug Administration (FDA) in the United States banned the sale of consumer antiseptic wash products containing triclosan in 2016. Approximately 40% of all soaps sold contained it. Is Triclosan Harmful? Triclosan has been used for years in many products due to its preservative function. However, recent studies on chemical preservatives have emphasized the hormone disrupting effects of this raw material. The damage it causes to the hormonal system in long-term use has been supported by many studies. Triclosan (Triclosan) Harms In vitro studies demonstrate the endocrine disrupting potential of Triclosan on estrogens, androgens, and the thyroid axis. According to a 2022 study by Ana C Marques et al., “The estrogenic and androgenic activity of Triclosan has been shown to have adverse effects on the reproductive system, cardiovascular system, and thyroid function in both animals and humans. Specifically, it has been found to affect male and female fertility, sperm morphology, and motility. In cardiovascular studies, Triclosan has been associated with heart defects in fish and mice, as well as inhibition of arterial contraction. In addition, Triclosan has been shown to reduce circulating thyroid hormone levels, alter the morphology of the thyroid gland, and interfere with thyroid hormone function.” The least understood aspect of TCS (Triclosan) is bioaccumulation and how this may relate to long-term health effects. Multiple urinalysis studies have shown the presence of TCS in subjects from around the world. In the US, 75% of 2517 participants were found to be positive for TCS in their urine at concentrations of 2.4–3790 μg/L, much higher than the initial detection level of 2.3 μg/L. TCS has also been detected in newborn cord blood. A study in New York City showed that 100% of urine samples from 181 pregnant mothers and 51% of cord blood samples from their babies contained TCS. Perinatal exposure to TCS in mouse models could be linked to impairment of neurogenesis and neuronal growth, which is then further associated with behavioral and social problems after birth, including decreased memory and increased anxiety-related behaviors. Although triclosan appears to have an effect on bacterial resistance to antibiotics in vitro, studies in the environment have not confirmed increased resistance. Its use in cosmetic products is considered safe for human health at authorized concentrations. Like all preservatives, the use of triclosan in cosmetic products is strictly regulated. However, ongoing research and regulatory reviews continue to evaluate its potential risks and benefits. Triclosan-Free Toothpaste Studies have accepted that the use of Triclosan in products as an antibacterial agent does not show a big difference compared to those not used and have not been able to explain its benefit. On the other hand, studies on its possible harms have revealed that there are many risks to the use of this raw material. While the same effect can be achieved by using natural antibacterial agents, the use of Triclosan, which contains many possible harms, is questionable. For this reason, it is possible to make a difference by using toothpastes that do not contain Triclosan and to provide a clean mouth without any doubt. Resources https://cosmileeurope.eu/inci/detail/16339/triclosan/ https://ec.europa.eu/growth/tools-databases/cosing/reference/annexes/list/V Marques AC, Mariana M, Cairrao E. Triclosan and Its Consequences on the Reproductive, Cardiovascular and Thyroid Levels. Int J Mol Sci. 2022;23(19):11427. Published 2022 Sep 28. doi:10.3390/ijms231911427 https://health.ec.europa.eu/latest-updates/sccs-scientific-advice-safety-triclocarban-and-triclosan-substances-potential-endocrine-disrupting-2022-11-04_en Papavasilopoulos, Rachel K, and Sanghoon Kang. “Bibliometric Analysis: The Effects of Triclosan on Human Health.” Toxics vol. 10.9 523. 1 Sep. 2022, doi:10.3390/toxics10090523
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Periodontitis and Gum Health
What is Periodontitis (Gum Recession)? Periodontitis is a type of gum disease characterized by inflammation and infection of the ligaments and bones that support the teeth. It often results in deep pockets between the teeth and gums, which can eventually lead to tooth loss. The disease is initiated and sustained by the oral microbial biofilm. It is also influenced by factors such as genetic susceptibility and environmental conditions. In addition, periodontitis has been epidemiologically associated with systemic disorders such as atherosclerosis, adverse pregnancy outcomes, rheumatoid arthritis, some cancers, and diabetes. 1 Periodontitis (Gum Recession) Symptoms Symptoms of periodontitis include bleeding gums, red/bluish-purplish discoloration, gum recession, gum enlargement, tooth displacement, spacing, elongation, loosening, abscess formation, sensitivity and bad breath. 3 Periodontitis (Gum Recession) Treatment Conventional treatment of periodontal disease includes surgical and nonsurgical periodontal therapy, which consists of mechanical cleaning combined with effective plaque control. However, mechanical cleaning is a difficult procedure due to limitations such as inaccessibility to deep pockets, surface irregularities, and furcation areas. At this stage, the aim is to reduce or eliminate pathogenic microorganisms that cannot be destroyed mechanically by antimicrobial treatment. 4 What is Good for Receding Gums? Receding gums are an irreversible condition, meaning that receding gum tissue will not grow back. However, you can take some precautions to prevent the problem from getting worse. Treatment depends on the cause of your gum disease. If the problem is caused by harsh brushing or poor oral hygiene, it's important to talk to your dentist about changing your brushing and flossing habits. Using a daily mouthwash that helps prevent plaque buildup and using tools such as interdental cleaners or dental floss to keep hard-to-reach areas clean can help. Mild gum recession can increase the risk of bacteria accumulating around pockets in the gums, but it does not automatically increase your risk of gum disease. However, in areas with existing gum disease, gum recession can cause the disease to progress more quickly. 2 Effective and proper oral hygiene is essential for this. Home Remedies for Receding Gum There are many different causes of gum recession, as well as many different solutions. In cases of gum recession caused by incorrect brushing, correct brushing techniques can be learned under the supervision of a dentist and applied. In addition, the progression of gum recession can be prevented by using gum-nourishing pastes. The cause of gum recession must be thoroughly investigated and its origin must be found. It is critical that the treatment method be determined by a professional based on this cause. Periodontitis (Gum Recession) Toothpaste Studies have proven over the years that herbs such as turmeric, sage and shepherd’s purse have positive effects on the treatment of receding gums. 5 Therefore, using oral care products containing these herbs will be a great help in dealing with receding gums. Resources Graziani F, Karapetsa D, Alonso B, Herrera D. Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontol 2000. 2017 Oct;75(1):152-188. doi: 10.1111/prd.12201. PMID: 28758300. https://www.healthline.com/health/receding-gums-treatment#treatments Jati AS, Furquim LZ, Consolaro A. Gingival recession: its causes and types, and the importance of orthodontic treatment. Dental Press J Orthod. 2016 Jun;21(3):18-29. doi: 10.1590/2177-6709.21.3.018-029.oin. PMID: 27409650; PMCID: PMC4944726. Imber JC, Kasaj A. Treatment of Gingival Recession: When and How? Int Dent J. 2021 Jun;71(3):178-187. doi: 10.1111/idj.12617. Epub 2021 Jan 29. PMID: 34024328; PMCID: PMC9275303. Rani N, Singla RK, Narwal S, Tanushree, Kumar N, Rahman MM. Medicinal Plants Used as an Alternative to Treat Gingivitis and Periodontitis. Evid Based Complement Alternat Med. 2022 Sep 6;2022:2327641. doi: 10.1155/2022/2327641. PMID: 37941972; PMCID: PMC10630018.
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PARABENS: FRIEND OR FOE?
What is Paraben? Parabens are a family of chemicals commonly used as preservatives in cosmetic products. These preservative raw materials can be used to prevent the formation of harmful bacteria and mold in cosmetics in order to protect both products and consumers. The family members that we can most often encounter on cosmetic product labels are methylparaben, propylparaben, butylparaben, and ethylparaben. Cosmetic products usually contain mixtures of different types of parabens. The six most commonly used types are methyl-, ethyl-, propyl-, isopropyl-, butyl-, and isobutylparaben. Methyl- and ethylparabens, called short-chain parabens, are usually used together, while butylparaben is usually used alone. Long-chain parabens, propyl- and butylparabens, have been associated with stronger estrogenic activity. Some studies have shown that their branched structures increase estrogenic activity and sensitivity potential. 1,2 Where is Paraben Found? Parabens are found in many cosmetic products that are frequently used today. Their main purpose is to protect the product and prevent bacterial growth. For this reason, they have been used as an effective preservative in water-based products for years. Products Containing Paraben Parabens are found in many products that people use regularly and are frequently used in products with a high water content such as shampoo and conditioner due to their preservative potential. This is found in a wide range of products such as moisturizers , skin cleansers , sunscreens, deodorants, shaving gels, toothpastes, and makeup products. Parabens that we are exposed to in daily life are absorbed by the skin, metabolized by the body, and excreted from our bodies through urine. 1 Paraben-Free Products If you are concerned about parabens or want to choose paraben-free products, it is very important to read product labels carefully. On the other hand, parabens allow consumers to make their choice without confusion because their names are easy to distinguish. Additionally, it may be beneficial to seek the advice of a dermatologist or specialist to choose the right product based on your skin's sensitivity and specific needs. What does Paraben-Free mean? Paraben-free products are usually introduced to the market with the phrases “paraben free” or “paraben-free”. These products are formulated using natural preservatives or alternative preservatives instead of paraben. However, the use of this claim has recently sparked controversy and it has been claimed that it is intended to disparage the paraben family, which is considered safe to use within certain limits by authorities. 3 As a result of all the evaluations, it can be said that using this claim on labels is legally becoming a thing of the past. It will no longer be possible to see the claims “Paraben Free” or “Paraben-Free” on labels. 4 Therefore, it is necessary to read the contents on the label carefully and choose products that do not leave room for doubt based on this. Are Parabens Harmful? Many studies have been conducted on this subject from past to present and some results have been reached. Within the framework of these results, the evidence of its harmfulness due to its accumulation in the body is too important to be ignored. Some governments and health institutions that have listened to these results have taken important steps and introduced some regulations regarding the use of the raw material. Paraben Harms Several studies have examined paraben levels in the bodies of women, men, teenagers and children who regularly use cosmetics , and have shown that personal care products are the biggest contributor to paraben exposure. The urine samples of young girls who wear daily makeup have been found to contain propylparaben levels 20 times higher than those who do not wear makeup or rarely wear makeup. Several studies have found that the use of body and facial lotions, hair products, sunscreens and makeup products containing parabens is associated with significant increases in paraben levels in urine. 5 Parabens are considered safe to use within certain limits in many countries, such as Europe and Turkey. The EU Commission's statement on the subject mentions the risks as follows: “The main concern about parabens in cosmetics is the potential for some to mimic hormones in the body, particularly the female sex hormone estrogen. In laboratory test systems and in animals, parabens have been shown to have some hormone-like effects, but these effects are thousands to millions of times weaker than the effects of natural hormones. Their hormone-like properties appear to increase with the size of the paraben molecule. However, other experimental studies to date on the possible effects of paraben use on reproduction have been inconclusive, and many have had shortcomings that make their results difficult to interpret.” 6 Following these statements, on the other hand, the Danish government banned the use of propyl-, isopropyl-, butyl- and isobutylparabens in cosmetic products specifically designed for children under the age of three in 2011. Thereupon, the SCCS committee, which continued its research on the safety of the relevant raw material, stated that it considered that it had adopted a cautious approach in its assessment, but shared that further research was needed to reduce uncertainties and more precisely assess the potential risk of parabens found in different cosmetic products on children. 6 As a result, parabens are currently present in many cosmetic products with effective preservative functions. Since their use is considered safe by authorities within certain limits, there is no harm in using them in cosmetics as long as the limits are respected. On the other hand, scientific studies have shown that paraben exposure increases due to the use of more than one paraben-containing cosmetic product per day, which also raises questions about their safety. As a result of the evaluation of significant doubts, some governments do not find their use appropriate, while others suggest that additional research should be conducted and more data should be collected. Therefore, since studies on the effects of parabens on health are ongoing, it may be difficult to reach a definitive conclusion about their harmfulness at the moment. However, in line with concerns, being able to reach cosmetic products that are free from doubts with a conscious choice is becoming an increasingly increasing demand. For this reason, there are many different options on the shelves for users who want to prefer paraben-free products. Resources https://www.fda.gov/cosmetics/cosmetic-ingredients/parabens-cosmetics Engeli RT, Rohrer SR, Vuorinen A, Herdlinger S, Kaserer T, Leugger S, Schuster D, Odermatt A. Interference of Paraben Compounds with Estrogen Metabolism by Inhibition of 17β-Hydroxysteroid Dehydrogenases. Int J Mol Sci. 2017 Sep 19;18(9):2007. doi: 10.3390/ijms18092007. PMID: 28925944; PMCID: PMC5618656. https://ec.europa.eu/growth/tools-databases/cosing/ https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32013R0655 Berger KP, Kogut KR, Bradman A, She J, Gavin Q, Zahedi R, Parra KL, Harley KG. 2018. Personal care product use as a predictor of urinary concentrations of certain phthalates, parabens, and phenols in the HERMOSA study. J Expo Sci Environ Epidemiol 29(1):21-32. https://ec.europa.eu/health/scientific_committees/docs/citizens_parabens_en.pdf
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Did Someone Say “SLS-Free”?
What is SLS? Sodium lauryl sulfate (SLS) is a surfactant, meaning it has an effect primarily on the surfaces it touches. It is used in a variety of products, including food thickeners, toothpastes, and floor cleaners. It stands out for its foaming function. What Does SLS Stand For? SLS (Sodium Lauryl Sulfate), also known as sodium dodecyl sulfate, is derived from coconut and/or palm kernel oil or synthetically and is used as an emulsifier in various formulations. 1 Are SLS and SLES the Same? Sodium lauryl sulfate (SLS) and sodium laureth sulfate (SLES) are anionic surfactants and detergents found in many cleaning and personal care products. Surfactants reduce the surface tension of water, allowing oil and dirt to be removed more easily. For example, dishwashing detergents cleanse oils, while shampoos remove accumulated oil from hair. SLS and SLES help to create foam in cleansing and skin care products to achieve the desired effect. The main difference between the two is that SLES undergoes an additional process called ethoxylation, making it gentler on the skin. 2 Which Products Contain SLS? SLS is found in a wide range of products. It is a surfactant with many different functions used in a variety of products including food, detergents and cosmetics, but in skin care it acts as a cleansing agent. Product Groups Containing SLS Many products we use in our daily lives contain SLS. These can be listed as facial cleansers , body washes and shower gels, shampoos, hand soaps, detergents, toothpastes and cleaning products for your home. Is SLS Harmful? There are many different opinions about the harmfulness of SLS. Its negative effect on the skin barrier does not seem to be a subject open to discussion. Studies have shown that it causes deterioration in the skin barrier function. SLS Harms The use of SLS in consumer products is regulated and its potential for irritation is evaluated in the context of the full product formulation. SLS-free cosmetics are formulated to be gentler on the skin, which can reduce the risk of irritation and allergic reactions. A study published in The Journal of Clinical and Aesthetic Dermatology concluded that water-based creams without SLS have a lower potential for irritation than water-based creams containing SLS. 3 Another study conducted in 2021 used patches containing SLS on a group of women. Analysis before and one day after removing the SLS patch revealed an increase in skin redness and a decrease in skin barrier function. It has been observed that an impaired skin barrier function and dehydration caused by the SLS patch disrupt the delicate balance of the skin microbiota leading to skin bacterial community dysbiosis. 4 SLS-Free Products SLS-free products offer many potential benefits in terms of being skin-friendly and minimizing the risk of allergic reactions. Using SLS in toothpastes, especially those that come into direct contact with oral tissue, can lead to disruption of oral balance. While the importance of oral health, which is the first step of digestion, is an undisputed fact, it is possible to provide effective cleaning with safe ingredients that are free of doubt. Resources https://www.chemicalsafetyfacts.org/chemicals/sodium-lauryl-sulfate-sls/ https://www.products.pcc.eu/en/blog/sles-and-sls-what-are-these-substances-and-where-are-they-used/ Mei-Hsia Chan M, Tan LS, Leow YH, Goon AT, Goh CL. Comparison of Irritancy Potential of Sodium Lauryl Sulfate-free Aqueous Cream to Other Moisturizers: An Intraindividual Skin Occlusive Study. J Clin Aesthet Dermatol. 2019 Jul;12(7):52-58. Epub 2019 Jul 1. PMID: 31531162; PMCID: PMC6715333. Leoty-Okombi S, Gillaizeau F, Leuillet S, Douillard B, Le Fresne-Languille S, Carton T, De Martino A, Moussou P, Bonnaud-Rosaye C, André V. Effect of Sodium Lauryl Sulfate (SLS) Applied as a Patch on Human Skin Physiology and Its Microbiota. Cosmetics. 2021; 8(1):6. https://doi.org/10.3390/cosmetics8010006
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Atopic Skin and the Right Approach
What Is Atopic Dermatitis (Eczema)? AAtopic dermatitis, commonly known as atopic eczema, is a chronic inflammatory skin condition characterized by dry, itchy, and inflamed skin. It is a common type of eczema that affects both children and adults, resulting from the complex interaction of genetic, environmental, and immunological factors.1 What Does Atopic Skin Mean? Atopic skin refers to skin prone to atopic dermatitis, also known as eczema. Atopic dermatitis leads to excessive itching, which can cause redness, swelling, cracking, clear fluid leakage, crusting, and flaking. Research shows that individuals with atopic dermatitis have a weakened skin barrier, making their skin more susceptible to irritants, allergens, and microbial invasions.2 What Causes Atopic Dermatitis (Eczema)? There is no single known cause of atopic dermatitis (eczema); it likely results from multiple contributing factors. Current theories explore the roles of the immune system, genetic mutations in skin structure, defects in skin cells (keratinocytes), the skin surface microbiome (bacteria, viruses, and yeasts), and several other factors. Causes of Atopic Dermatitis (Eczema) The pathophysiology of atopic dermatitis involves a combination of genetic predisposition, immune dysregulation, and environmental triggers. Mutations in genes encoding proteins involved in skin barrier function, such as filaggrin, play a significant role in the development of atopic dermatitis. These genetic variations compromise the skin's ability to retain moisture, leading to dryness and increased permeability. This allows allergens and irritants to penetrate the skin more easily, triggering inflammatory responses. The primary causes can be summarized as genetic factors, epidermal barrier dysfunction, immunological mechanisms, and environmental triggers. 2 Symptoms of Atopic Dermatitis (Eczema) In the acute phase, lesions present as intensely itchy, red, thickened, and scaly patches or plaques, which may become eroded due to scratching. In the chronic phase, prolonged scratching and rubbing result in dry, lichenified (hardened) skin lesions. The distribution of lesions is age-specific. In infants, lesions are most commonly seen on the face, scalp, neck, eyelids, and extensor surfaces of the extremities. In older children and adults, lesions occur on flexor surfaces such as the neck, inner elbows, and back of the knees. Severe itching is a hallmark of atopic dermatitis. Itching usually precedes lesions and is worsened by dry air, sweating, local irritation, wool clothing, and emotional stress. 3 Common environmental triggers of symptoms include: Excessive bathing or washing Hard soaps Staphylococcus aureus skin colonization Sweating Rough fabrics and wool Is Atopic Dermatitis (Eczema) Contagious? Atopic dermatitis is not contagious, so it cannot be spread from person to person. Atopic Dermatitis (Eczema) Treatment Treatment of atopic dermatitis is most effective by addressing the underlying pathophysiological processes. Counseling on appropriate skin care and avoidance of triggers helps patients manage the underlying skin barrier defect. Scratching of pruritic lesions often increases pruritus, which leads to further scratching. It is important to break the itch-scratch cycle. General skin care should focus on the most common sources of skin irritation (over-washing and harsh soaps): Limiting the frequency and duration of washing and bathing Keeping the temperature of the bath water at lukewarm Avoid excessive scrubbing, instead gently pat the skin dry after showering/bathing. Applying a moisturizer ( ointment or cream—products containing ceramides are especially helpful) Reducing emotional stress is helpful and helps break the itch-scratch cycle . Does Eczema Go Away On Its Own? Since this condition is completely related to immunity, it is also possible for it to go away on its own. What is Good for Eczema? According to the article written by Chang et al., there is more than one treatment method. Topical Corticosteroids: One of the most commonly used treatments for eczema. Corticosteroid creams help reduce inflammation in the skin and relieve itching. However, long-term use can cause side effects such as thinning of the skin. Moisturizers and Wet Wraps: Keeping the skin hydrated is an important step in managing eczema. Moisturizers help prevent water loss from the skin. Wet wraps help retain moisture for longer periods of time and reduce itching. Antihistamines: These drugs are used especially to relieve itching and are also preferred to help with sleep. Topical Immunomodulators (Tacrolimus and Pimecrolimus): These medications reduce inflammation by regulating the skin's immune response. They are used as an alternative to corticosteroids and may be safer with long-term use. Phototherapy (UVB): Ultraviolet light therapy slows the growth of skin cells and reduces inflammation. This may be used in severe cases of eczema. Oral immunosuppressants: Medications such as cyclosporine A, methotrexate and azathioprine relieve eczema symptoms by suppressing the immune system. However, these medications can have serious side effects and are usually only recommended for severe cases. Natural and Alternative Treatments: Alternative treatments such as probiotics and nutritional supplements can also be used to manage eczema. Probiotics have been shown to reduce the risk of eczema, especially in infants. The effectiveness of these treatment methods may vary depending on the patient's condition, and the treatment plan should be determined by a dermatologist or allergist. 1 Products for Atopic Dermatitis (Eczema) The products to be used for atopic dermatitis should primarily have gentle ingredients due to the sensitivity of the skin. It is important to choose products that will not irritate the skin and will support its repair. The atopic dermatitis care set, especially prepared with ceramide, skin amino acids, minerals and effective natural extracts, supports the relief and renewal of the skin while helping to reduce its symptoms. Moisturizing the skin is another important requirement. To achieve this, it is of great importance to use products with high moisturizing properties and safe ingredients. Resources Chang C, Keen CL, Gershwin ME. Treatment of eczema. Clin Rev Allergy Immunol. 2007 Dec;33(3):204-25. doi: 10.1007/s12016-007-0033-8. PMID: 18163227. Avena-Woods C. Overview of atopic dermatitis. Am J Manag Care. 2017 Jun;23(8 Suppl):S115-S123. PMID: 28978208. https://nationaleczema.org/eczema/ Ruenger, T. M. (2023, January). Atopic dermatitis (eczema). In Merck Manual . Georg-August University of Göttingen, Germany. https://www.msdmanuals.com/professional/dermatologic-disorders/dermatitis/atopic-dermatitis-eczema
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