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FDA warning on surma

The US-based Food and Drug Administration Authority has long issued a warning on the traditional eye cosmetic known as kohl, kajal, al-kahl, or surma. According to the authority, people may not be aware that using these products carries the risk lead poisoning, in adults and children, from an easily avoidable source.
The following information is intended to answer questions people may ask about kohl and its dangers:

What is kohl made of?
Samples tested often contain significant amounts of lead. Lead sometimes accounts for more than half the weight of a sample of kohl, usually in the form of lead sulfide. Kohl may also contain a variety of other materials, such as aluminum, antimony, carbon, iron, and zinc compounds, as well as camphor and menthol

What are the effects of lead poisoning?
The risks associated with exposure to lead are especially serious for children, who are particularly susceptible to absorbing lead from the environment. Among the effects associated with high levels of exposure are anemia, kidney problems, and neurological damage that may include seizures, coma and death. Even at relatively low levels, chronic exposure to lead may lead to learning and behavior problems.

Is kohl directly linked to increased levels of lead in children?
Yes. FDA has learned of recent instances of kohl-related lead poisoning in children in the U.S. A number of studies have shown that children exposed to kohl have increased levels of lead in their blood. This exposure puts them at increased risk for the serious consequences of lead poisoning.

How are children exposed to kohl?
In some cultures, it is common for parents to apply kohl to the eyes of infants and children. Infants of mothers who use kohl sometimes have elevated levels of lead in their blood. Also, some people traditionally paint a newborn's umbilical stump with kohl, supposedly for medicinal reasons. Unlike some sources of exposure to lead, this one is easily avoidable by not using kohl on your children or yourself, and keeping it out of your home.

If someone in my family has been exposed to kohl, what should I do?
Stop all use of kohl immediately and be especially careful to protect children from further exposure. Place unused kohl in a sealable container or plastic bag and contact your local sanitation or waste department regarding appropriate methods for disposal. Thoroughly wash hands and any other body parts that may have come in contact with kohl. Wash exposed household surfaces with soap and hot water. Ask a health care provider to test children as well as pregnant or nursing women for lead poisoning if they have used kohl.

Is kohl legal in the United States?
No. Kohl is a color additive as that term is defined in the Federal Food, Drug and Cosmetic Act (FD&C Act), and there is no regulation permitting its use in a cosmetic or in any other FDA-regulated product. Color additives (other than coal-tar hair dyes) that are not permitted by regulation are considered unsafe under the law.
FDA has an Import Alert in effect for cosmetics containing kohl, not only because it is an unsafe color additive, but also because of labeling violations. For example, some samples have been labeled with the false statement, "FDA Approved." Such products are subject to detention and refusal of admission at U.S. ports of entry. NOTE: Some manufacturers may label eye cosmetics with the term "kohl" simply to indicate the shade, not because the product actually contains kohl. If the product is properly labeled, consumers can check the ingredient declaration to determine whether it contains only color additives that are approved for cosmetic use in the area of the eye. If no color additives are declared, it would be wise to stay on the safe side and assume that the product is, in fact, kohl.

Where does kohl come from?
Popular in much of the world since ancient times, particularly in parts of Africa, the Middle East, Iran, Pakistan, and India, kohl now sometimes appears in Europe and North America, especially in some Middle Eastern and Asian specialty markets. Despite its illegal status in the United States, it may be imported surreptitiously, for example, in personal luggage. It also has been advertised for mail order on some websites.

For more detailed local stories:

Surma: Can’t you see how bad it is? (The Express Tribune, 2013)
Growing toxicity of heavy metals posing serious health risks’ (The News, 2013)
Karachi exposed to acute lead pollution (Dawn, 2009)