Traditional Surma Eye Makeup Caused Lead Poisoning Cases Among New York Family Members, CDC Reports

A family of five in New York suffered lead poisoning from an eyeliner product traditionally used in other countries around the world, leading federal health investigators to call for the safer production of cultural products manufactured abroad.

The U.S. Centers for Disease Control and Prevention (CDC) published a case study last week in it’s Morbidity and Mortality Weekly Report, detailing the lead poisoning of a mother and her four young children over 11 years, which was caused by the use of traditional surma eye makeup.

Surma is a traditional cosmetic product used in different cultures in Asia, Africa, and the Middle East. It is primarily made of kohl, but recipes vary depending on the region. It can include grinding lead sulfide, charcoal, or mixing in plant oils or gum resins.

Because of how surma is made, it is recognized as a source of lead exposure and banned in the United States. However, travelers often purchase the product when visiting abroad and bring it into the country, where it can still pose a risk of lead poisoning.

According to the CDC report, the lead poisoning cases caused by the surma makeup surfaced after a 4-year-old in New York City was found to have dangerous lead blood levels. In 2012, testing found that the child had a blood lead level of 3.5 μg/dL, which is high enough to pose concerns about long-term developmental problems and brain damage.

During the investigation, four other members of the same family members were also found to have lead poisoning from 2012 to 2016, including the child’s mother and three younger siblings,

Investigators determined the only source of lead exposure for all cases was surma. Testing the suspected cosmetics found they contained lead at levels of 390,000 parts per million (ppm).

CDC researchers called for comprehensive family follow-up once one family member tests positive for lead exposure to prevent others from exposure to the same source. CDC health experts also said they recognize it may be difficult to communicate health warnings and exposure concerns when persistent unsafe cultural practices result in exposure.

Researchers said a comprehensive effort is needed, involving local and global health officials, to help promote the reformulation of unsafe products in the countries of origin to eliminate lead as an ingredient. This would help make safer products that don’t harm human health but continue to fulfill cultural practices, CDC investigators indicated.

Lead Poisoning Risks

Lead is toxic heavy metal that can cause permanent brain damage or other severe, long-term health consequences, especially to children, who are still developing and often do not show immediate signs or symptoms of lead exposure. Even short-term lead exposure can cause symptoms like headache, abdominal pain, vomiting, and anemia. Long-term exposure can cause irritability, lethargy, fatigue, muscle aches, constipation, difficulty concentrating, tremors, and weight loss.

Prior studies have linked childhood lead exposure to changes to the brain’s structural integrity, which can result in cognitive problems and reduced IQ scores later in life. Children can experience long-term brain damage even at low levels of lead exposure.

According to the American Academy of Pediatrics (AAP), there is no safe lead exposure level for children. Any exposure can increase the risk of developing injuries to the nervous system and brain. It can also cause seizures, convulsions, mental retardation, delayed growth, obesity, coma, and even death.

Federal health officials warned that anyone who has been exposed to lead should contact their healthcare provider or seek medical attention. Consumers suffering from side effects of lead poisoning should report the symptoms to the FDA’s MedWatch Adverse Event Reporting system.