New progress and challenges in the diagnosis and treatment of cosmetic allergy-related adverse reactions / 中华预防医学杂志

In China, the current standard for cosmetic adverse reactions related skin disease (GB/T 17149.1-1997) was jointly issued by the Ministry of Health and the State Bureau of Technical Supervision in 1997, cosmetic-allergic adverse reactions include allergic contact dermatitis and photo-allergic contact dermatitis according to this standard. The increasing use and changes in cosmetic ingredients or formula lead to a significant increase for the incidence of adverse reactions as the cosmetics industry is developing rapidly in the last 20 years. In the meantime, the clinical manifestations have become more diverse. In recent years, there have been many reports on the special manifestations for cosmetic allergy and allergen test, which provide a reference for the subsequent improvement of the diagnosis and prevention.

Report on a case of significant increase in urine mercury due to excessive mercury in cosmetics / 中华劳动卫生职业病杂志

Mercury is highly toxic and can be absorbed through skin contact. From December 5, 2020 to February 16, 2021, occupational disease laboratory of the First People's Hospital of Baiyin received 30 urine mercury test samples from a beauty salon in Lanzhou City. The test results showed that 28 samples exceeded the normal value (normal value: 4 μg/g Cr) . 15 patients were treated with sodium dimertopropyl sulfonate for mercury removal and tiopron for liver protection, and the prognosis was good.

Allergic contact dermatitis to cosmetics: retrospective analysis of a population subjected to patch tests between 2004 and 2017

Abstract Background: Cosmetics are part of the daily life of the population, and their use can lead to allergic contact dermatitis. Objectives: To assess the profile of patients diagnosed with allergic contact dermatitis to cosmetics treated at a referral center for 13 years, as well as the characteristics of the clinical picture and allergens involved. Methods: This was a retrospective study, with analysis of medical records of patients attended at this service. The individuals included had a diagnostic hypothesis of allergic contact dermatitis to cosmetics and had previously been submitted to epicutaneous tests. Results: A total of 1405 medical records were analyzed, 403 (28.7%) with suspected allergic contact dermatitis to cosmetics and 232 (16.5%) with confirmed diagnosis. Of these, 208 (89.7%) were women, and the age group most affected was 31 − 60 years. The most common locations were face in 195 cases (25.8%), cervical region in 116 (15.3%), and trunk in 96 (12.6%). The main allergens in the contact tests were toluene-sulfonamide-formaldehyde resin in 69 cases (29.7%), paraphenylenediamine in 54 (26.3%), Kathon CG® in 41 (20.7%), and fragrance-mix 1 in 29 (16.4%). In 154 (66.4%) of the 232 patients with a confirmed diagnosis of allergic contact dermatitis to cosmetics it was possible to specify the cosmetic product responsible for the lesions. Study limitations: The absence of some allergens considered important in the world as causes of allergic contact dermatitis, which are not readily accessible among us. Conclusions: The data of the analyzed population (predominance of young women), as well as the location of the lesions (face and cervical area) and the main allergens involved were consistent with those from the world literature.

High rate of sensitization to Kathon CG, detected by patch tests in patients with suspected allergic contact dermatitis

Abstract Background: Kathon CG, a combination of methylchloroisothiazolinone and methylisothiazolinone, is widely used as preservative in cosmetics, as well in household cleaning products, industrial products such as paints and glues. It has emerged as an important sensitizing agent in allergic contact dermatitis. Objectives: This study evaluated the reactivity to this substance in patients subjected to patch tests at the Dermatology Institute in Bauru, São Paulo from 2015 to 2017 and its correlation with other preservatives, the professional activity and location of the lesions. Methods: The patients were submitted to standard series of epicutaneous tests, standardized by the Brazilian Group Studies on Contact Dermatitis. Results: Out the 267 patients tested, 192 presented positivity to at least one substance and 29 of the patients (15.10%) presented reaction to Kathon CG, with predominance of the female gender (n = 27); main professional activity associated with Kathon CG sensibilization was cleaning (17.24%), followed by aesthetic areas (13.79%) and health care (10.34%). The most prevalent sensitizations among the substances tested were nickel sulphate (56.3%), followed by cobalt chloride (23.4%), neomycin (18.2%), potassium dichromate (17.7%), thimerosal (14.5%), formaldehyde (13.2%), paraphenylenediamine (9.3%), and fragrance mix (8.3%). Study limitations: We do not have data from patients that were submitted to patch test a decade ago in order to confront to current data and establish whether or no sensitization to Kathon CG has increased. Conclusion: High positivity to Kathon CG corroborates the recent findings in the literature, suggesting more attention to concentration of this substance, used in cosmetics and products for domestic use.

Bathing, make-up, and sunscreen: which products do children use? / Banho, maquiagem e protetor solar: o que as crianças usam?

ABSTRACT Objective: To evaluate the hygiene practices and frequency of use of personal hygiene products, cosmetics, and sunscreen among children and adolescents. Methods: Cross-sectional study with interviews about skincare conducted with caregivers through closed-ended questions. We included patients up to 14 years of age waiting for consultation in pediatric outpatient clinics of a tertiary hospital. We performed a descriptive statistical analysis and applied the Kruskal-Wallis test and Fisher's exact test to compare the practices according to maternal schooling. Results: We conducted 276 interviews. The median age of the participants was age four, and 150 (54.3%) were males. A total of 143 (51.8%) participants bathed once a day and 128 (46.3%) bathed two or more times a day, lasting up to ten minutes in 132 (47.8%) cases. Adult soap was used by 103 (37.3%) children and bar soap by 220 (79.7%). Fifty-three (19.2%) participants used sunscreen daily. Perfume was used by 182 (65.9%) children, hair gel by 98 (35.5%), nail polish by 62 (22.4%), and some type of make-up by 71 (25.7%) - eyeshadow by 30 (10.8%), lipstick by 52 (18.8%), face powder and mascara by 13 (4.7%). Make-up use started at a median age of 4 years. Henna tattoo was done in eight children. Conclusions: The children studied used unsuitable products for their skin, such as those intended for adults, used sunscreen inadequately, and started wearing make-up early, evidencing the need for medical orientation.

RESUMO Objetivo: Avaliar os hábitos de higiene e a frequência do uso de produtos de higiene pessoal, cosméticos e protetor solar nas crianças e adolescentes. Métodos: Estudo transversal com entrevistas para cuidadores sobre cuidados com a pele, por meio de perguntas fechadas. Incluídos pacientes de até 14 anos que consultavam nos ambulatórios pediátricos de um hospital terciário. Realizada estatística descritiva e aplicados os testes de Kruskal-Wallis e exato de Fisher para comparar os hábitos conforme a escolaridade materna. Resultados: Foram realizadas 276 entrevistas. A mediana de idade foi de 4 anos, sendo 150 (54,3%) crianças do sexo masculino. O número de banhos por dia foi de um em 143 (51,8%) casos e dois ou mais por parte de 128 (46,3%) indivíduos, com duração de até dez minutos em 132 (47,8%) dos participantes. O sabonete destinado a adultos era utilizado por 103 (37,3%) crianças e o sabonete em barra por 220 (79,7%) delas. Protetor solar era utilizado diariamente por 53 (19,2%) participantes. Perfume foi utilizado por 182 (65,9%) integrantes da amostra, gel de cabelo por 98 (35,5%), esmalte por 62 (22,4%) e algum tipo de maquiagem por 71 (25,7%) - sombra em 30 (10,8%), batom em 52 (18,8%), pó facial e rímel em 13 (4,7%). A mediana de idade de início do uso de maquiagem foi de 4 anos. Tatuagem de hena foi realizada em oito crianças. Conclusões: As crianças estudadas utilizavam produtos inadequados para a sua pele, como os destinados à pele do adulto, e faziam uso incorreto do protetor solar e uso precoce de maquiagem, mostrando a importância da orientação médica.

Brazilian version of the shriners hospital upper extremity evaluation (shuee): translation, cultural adaptation, and evaluation of psychometric properties / Versão brasileira do shriners hospital upper extremity evaluation: tradução, adaptação cultural e validação das propriedades psicométricas

ABSTRACT Objective: To validate the upper limb assessments tool, Shriners Hospital Upper Extremity Evaluation (SHUEE), for individuals with hemiplegic cerebral palsy in the Brazilian population. Methods: Validation study to translate and culturally adapt the Manual and the instrument. The psychometric properties evaluated were reliability and convergent validity. Reliability was determined by internal consistency (Cronbach's α coefficient), ceiling and floor effect, sensitivity to changes, and intra- and interobserver agreement. Convergent validity was performed using the Pediatric Motor Activity Log, the self-care scale of the Pediatric Evaluation of Disability Inventory, and the Manual Ability Classification System. Results: We evaluated 21 individuals with hemiplegic cerebral palsy, with a mean age of 8.7±4.0 years. After the instrument was translated, there was no need for cultural adaptation. The total Cronbach's α coefficient was 0.887 (95% confidence interval [95%CI] 0.745-0.970). We calculated sensitivity to changes in five subjects who underwent treatment with Botulinum Toxin Type A and physical therapy, with a significant difference between pre- and post-treatment evaluations in the Spontaneous Functional Analysis and Dynamic Positional Analysis. Convergent validity showed a significant correlation of the Spontaneous Functional Analysis and Dynamic Positional Analysis with the scales evaluated. All items of SHUEE presented high intra- and interobserver agreement. Conclusions: The results revealed that the Brazilian version of the SHUEE demonstrated good reliability and convergent validity, suggesting that it is an adequate and reliable tool for individuals with hemiplegic cerebral palsy in the Brazilian population.

RESUMO Objetivo: Validar o instrumento de avaliação do membro superior, Shriners Hospital Upper Extremity Evaluation (SHUEE), para indivíduos com paralisia cerebral hemiplégica da população brasileira. Métodos: Estudo de validação no qual foi realizada tradução e adaptação cultural do manual e do instrumento. As propriedades psicométricas avaliadas foram confiabilidade e validade convergente. A confiabilidade foi determinada através da consistência interna (coeficiente α de Cronbach), efeito teto e chão, sensibilidade à mudança e concordância intra e interobservador. A validade convergente foi realizada utilizando-se o Pediatric Motor Activity Log, a escala de autocuidados do Pediatric Evaluation of Disability Inventory e o Manual Ability Classification System. Resultados: Foram avaliados 21 indivíduos com paralisia cerebral hemiplégica com idade média de 8,7±4,0 anos. Após a tradução do instrumento, não houve necessidade de adaptação cultural. O coeficiente α de Cronbach total foi de 0,887 (intervalo de confiança de 95% [IC95%] 0,745-0,970). A sensibilidade à mudança foi calculada em cinco indivíduos que realizaram aplicação de Toxina Botulínica tipo A e fisioterapia, apresentando diferença significativa entre a avaliação pré e pós-tratamento na Análise Funcional Espontânea e Análise Posicional Dinâmica. A validade convergente mostrou correlação significativa da Análise Funcional Espontânea e Análise Posicional Dinâmica com as escalas avaliadas. Todos os itens do SHUEE apresentaram concordâncias fortes, tanto na avaliação intra quanto na interobservador. Conclusões: A versão brasileira do SHUEE demonstrou um bom desempenho em relação à confiabilidade e validade convergente, sugerindo ser uma ferramenta adequada e confiável para os indivíduos com paralisia cerebral hemiplégica na população brasileira.

Evaluation of the presence of allergens in children's products available for sale in a big city

Abstract: Children's products are considered safe by the general population and doctors. Labels with terms such as "hypoallergenic" or "dermatologically recommended and tested" denote trust and credibility with the idea that they can be used by any individual. Patients with allergic contact dermatitis may be sensitive to allergens present in any product, including children's. There is insufficient knowledge about allergens in these products in our country. We evaluated 254 children's products, and at least one allergen was present in 236 (93%) of them. The indication of a topical product should be careful and based on contact tests.

Sensitive skin: review of an ascending concept

Abstract: Sensitive skin is a condition characterized by stinging, burning and itching sensations. The diagnosis, pathophysiology and treatment of sensitive skin are still under discussion. In the last years, studies on its epidemiology have been performed, showing a high prevalence and impact on quality of life. Brazilian population was also considered in these studies. Cosmetics, climate changes and skin barrier impairment are the main factors that contribute for skin hyperreactivity. New studies are trying to bring new knowledge about the theme. This review will describe data on epidemiology, triggering factors, pathophysiology, diagnosis and treatment.

Allergy to hypoallergenic nail polish: does this exist?

Abstract The main allergen responsible for contact dermatitis to nail polish is tosylamide-formaldehyde resin. The so-called hypoallergenic nail polishes are suposedly free of agents that commonly trigger reactions. The commercially available products and their compositions were studied. It was observed that most brands present at least one component capable of triggering the disease; therefore, allergic reaction may occur even when hypoallergenic polishes are used. There should be a proper investigation of the specific allergen through a patch test, because more than one component can cause an allergy, and we need to check the exact composition of each product.

Unilateral acanthamoeba keratitis following the use of cosmetic contact lens

Colored lenses were first designed for patients with eye pathologies, such as aniridia or corneal opacity. However, in recent years they have become readily available over-the-counter as cosmetic accessories. Widespread use of these lenses has been noted among young adults. Acanthamoeba keratitis is a rare cause of corneal infection, which is associated with poor visual prognosis. Over the past ten years, improvements in the management of this infection have been documented, yet the best treatment is still primary prevention. Hence, contact lens wearers must be provided with proper instructions regarding contact lens hygiene. We present a case of unilateral Acanthamoeba keratitis in a cosmetic contact lens wearer who presented with a month history of right eye pain, photophobia, redness and blurred vision. The contact lenses were obtained over the counter, and a history of poor contact lens hygiene was found. The patient was started on empirical treatment initially. The treatment was modified once the diagnosis was confirmed via Giemsa Stain of corneal scrapings, which showed Acanthamoeba cysts. The patient improved markedly and was discharged from the hospital. The disease classically has a slowly progressive, chronic course, with frequent remission periods. Our patient was lost to follow-up due to poor compliance and failure to adhere to guidelines

Adverse reactions to cosmetic products and the Notification System in Health Surveillance: a survey / Reacoes adversas aos produtos cosmeticos e o Sistema de Notificacao em Vigilancia Sanitaria: um inquerito

INTRODUCTION: This paper is part of a study that investigates the quality of cosmetic products and evaluates the cosmetic surveillance system. OBJECTIVE: This study presents the results of a research that aimed to describe the point of view of the population in terms of the prevalence of Adverse Reactions (AR) and information about the surveillance system. METHODS: A structured questionnaire was applied to a random sample of 200 people from the administrative staff of the Municipal Guard of Rio de Janeiro. RESULTS: 38% of the participants declared AR to some cosmetic product used in the past two years. CONCLUSION: To our knowledge, this is an unpublished study in Brazil, which presents results regarding the estimated prevalence of AR similarly to international studies. .

INTRODUÇÃO: Este trabalho integra um estudo que investiga a qualidade dos produtos cosméticos e avalia o sistema de cosmetovigilância. OBJETIVO: Ele apresenta os resultados de um inquérito cujo objetivo foi descrever o ponto de vista populacional em termos da prevalência de Reações Adversas (RA) e informações sobre o sistema de vigilância. MÉTODOS: Um questionário estruturado foi aplicado a uma amostra aleatória de 200 funcionários administrativos da Guarda Municipal do Rio de Janeiro. RESULTADOS: 38% dos participantes declararam RA a algum produto cosmético utilizado nos últimos dois anos. CONCLUSÃO: Pelo nosso conhecimento, este é um estudo inédito no Brasil que apresenta resultados em relação à prevalência de RA estimados de forma semelhante aos das pesquisas internacionais. .

Study of the frequency of allergens in cosmetics components in patients with suspected allergic contact dermatitis / Estudo da frequência dos alérgenos da bateria de cosméticos em pacientes com suspeita de dermatite alérgica de contato

BACKGROUND: Contact dermatitis to cosmetics is a common dermatosis, especially in adults and professionals who handle them. OBJECTIVE: The objective of this study was to evaluate the frequency of sensitization to cosmetics' components in patients with suspected allergic contact dermatitis and to identify the main sensitizers related to occupational contact dermatitis. METHODS: During the period of January 2008 to June 2010, all the patients with a presumptive diagnosis of allergic contact dermatitis to cosmetics were selected. The patients were submitted to the patch tests of cosmetics series, composed by ten substances. RESULTS: Among the 147 patients studied sensitization to cosmetics components occurred in 31,29% of the cases, 14 of those (19,18%) equally corresponding to BHT and triethanolamine substances, 13 (17,81%) to ammonium thioglycolate, 09 to sorbic acid (12,33%), 08 to tosilamida (10,95%), 06 to germall (8,22%). The other elements tested showed indices of 5% or less. A higher frequency of contact dermatitis to cosmetics was observed in women and the age most affected was concordant with the age range of greatest professional activity of the population. CONCLUSION: Allergic contact dermatitis was more frequently associated with Triethanolamine, BHT and ammonium thioglycolate, and the relation with occupational contact dermatitis was discreet.

FUNDAMENTOS: A dermatite de contato por cosméticos é uma dermatose relativamente comum, sobretudo em adultos e em profissionais que os manipulam. OBJETIVO: O objetivo do estudo foi avaliar a freqüência de positividade aos componentes de cosméticos, em pacientes com suspeita de dermatite alérgica; e identificar os principais sensibilizantes relacionados à dermatite de contato ocupacional. MÉTODOS: Durante o período de janeiro de 2008 a junho de 2010 foram selecionados todos os pacientes com hipótese de dermatite alérgica de contato a cosméticos. Os pacientes foram submetidos aos testes epicutâneos com bateria de cosméticos, composta por dez substâncias. RESULTADOS: Dos 147 pacientes estudados, a sensibilização aos componentes do cosmético ocorreu em 31,29% dos casos, sendo 14 (19,18%) corresponderam igualmente às substâncias BHT e trietanolamina, 13 (17,81%) ao tioglicolato de amônia, 09 ao ácido sórbico (12,33%), 08 tonsilamida (10,95%), 06 germal (8,22%). Os demais elementos testados proporcionaram índices iguais ou inferiores a 5%. Observou-se maior freqüência de dermatite de contato aos componentes da bateria de cosméticos em mulheres e a idade mais acometida foi concordante com a faixa etária de maior atividade profissional da população. CONCLUSÕES: Houve maior freqüência de dermatite alérgica de contato pelas substâncias trietanolamina, BHT e tioglicolato de amônia, demonstrando pouca associação à dermatite de contato ocupacional.

Avaliação das medidas de oximetria de pulso em indivíduos sadios com esmalte de unha / Evaluation of pulse oximetry measurements in healthy subjects with nail polish

OBJETIVO: Avaliar as alterações nas medidas da oximetria de pulso em indivíduos sadios com esmaltes de unha. MÉTODOS: Estudo transversal com 80 voluntárias sadias. As cores de esmalte utilizadas para avaliar a saturação periférica de oxigênio (SpO2) foram: café com leite, café, chocolate, vermelho e ameixa. Estas cores foram distribuídas entre as unhas dos dedos da mão esquerda. Os dedos da mão direita foram os controles. RESULTADOS: As cores vermelha (p=0,047) e café (p=0,024) mostraram valores menores na SpO2 quando comparados ao controle. As outras cores não alteraram a medida da SpO2. CONCLUSÃO: As cores vermelha e café causaram redução na medida da SpO2, porém a relevância clínica deste achado é questionável, pois os valores estavam dentro do intervalo de normalidade.

OBJECTIVE: To evaluate the changes in measurements of pulse oximetry in healthy individuals with nail polish. METHODS: Cross sectional study with 80 healthy volunteers. The colors of enamel used to assess oxygen saturation (SpO2) were: coffee with milk, coffee, chocolate, red and plum. These colors were distributed among the finger nails of his left hand. The fingers of the right hand were the controls. RESULTS: The colors red (p = 0.047) and coffee (p = 0.024) showed lower values in SpO2 in comparison to the control. The other colors did not change the measurement of SpO2. CONCLUSION: The colors red and coffee caused reduction in the measurement of SpO2, but the clinical relevance of this finding is questionable, because the values were within the normal range.

OBJETIVO: Evaluar las alteraciones en las medidas de la oximetría de pulso en individuos sanos con esmalte de uña. MÉTODOS: Estudio transversal realizado con 80 voluntarias sanas. Los colores de esmalte utilizados para evaluar la saturación periférica de oxígeno (SpO2) fueron: café con leche, café, chocolate, rojo y ciruela. Estos colores fueron distribuidos entre las uñas de los dedos de la mano izquierda. Los dedos de la mano derecha fueron los controles. RESULTADOS: Los colores rojo (p=0,047) y café (p=0,024) mostraron valores menores en la SpO2 cuando fueron comparados al control. Los otros colores no alteraron la medida del SpO2. CONCLUSIÓN: Los colores rojo y café causaron reducción en la medida del SpO2, sin embargo la relevancia clínica de este hallazgo es cuestionable, pues los valores estaban dentro del intervalo de normalidad.

Effect of lipstick on composite resin color at different application times

OBJECTIVES: The aim of this study was to evaluate the influence of the contact of two lipsticks, one with common fixer and one with ultra fixer, on the color of a composite resin immediately, 30 min and 24 h after photoactivation. MATERIAL AND METHODS: Ninety specimens were prepared with a composite resin, Filtek-Z350. Specimens were polished and divided into 9 groups (n=10) according to time elapsed after photoactivation (A- immediately; B- 30 min; C- 24 h) and the contact with lipstick (UF- lipstick with ultra fixer; F- lipstick with common fixer). The control group was represented by specimens that did not have any contact with lipstick (C- without lipstick). Color measurements of the specimens were carried out using a spectrophotometer (Easyshade - CIE L* a* b* system). For UF and F groups, the baseline color of the specimens was measured immediately before pigmentation and the lipsticks were applied dry after 1 hour. The excess lipstick was removed with absorbent paper and final color checking was performed, including the control group. Differences between the final and baseline color measurements were calculated and data were analyzed statistically by the Kruskal-Wallis test at 5 percent. RESULTS: The means between the differences of color values were: AUF: 16.0; AF: 12.4; AC: 1.07; BUF: 9.51; BF: 8.3; BC: 0.91; CUF: 17.7; CF: 12.41; CC: 0.82. CONCLUSION: Groups where lipstick was applied showed greater staining than the control group at the three evaluation times. The lipstick with ultra fixer stained more than the lipstick with common fixer. Time elapsed between photoactivation and contact with lipstick had a similar influence on the groups that received lipstick application.

Estudo clínico, monocego, da tolerabilidade cutânea e eficácia preventiva de assaduras de um produto tópico*, em condições reais de uso / A monoblind clinical trial study of cutaneous tolerability and preventive efficacy for diaper's rash os a topic product in real life or real use conditions

O uso crescente de produtos cosméticos tem sido cada vez mais comum em nosso meio, fazendo parte do receituário médico. O presente estudo tem por finalidade determinar a prevalência de reações adversas, em condições reais de uso, de um hidratante infantil contendo alantoína e alfa-bisabolol. Também foi avaliada a eficácia preventiva de assaduras.

Kohl [SURMA]: retrospect and prospect

Kohl, since antiquity has always been given a prime importance in ophthalmology for the protection and treatment of various eye ailments. However, for decades various conflicting reports in the literature have been published relating to Kohl application to eyes being responsible for causing higher blood lead concentration, which may cause lead poisoning. While at the same time, a number of research studies and reports have also been published negating any such links with increased blood lead level upon Kohl [surma] application. In view of the above mentioned facts, this review article is written with the objective to highlight various data from past and present research studies and reports about Kohl, so as to provide valuable information to both the users and the research workers about it-s scientific background and effects when applied into eyes. A large number of items and topics [such as Kohl, surma, eye cosmetic, traditional eye preparations, environmental lead pollution, galena, lead sulphide etc.] have been taken into consideration while compiling this review article. In conclusion, the authors of this review article feel that the relation between Kohl and toxicity or increased blood lead concentration upon it-s application to eyes as reported elsewhere is likely to be more of theoretical nature rather than a practical health hazard

"Kohl" use for infants

Kohl is still being used for the eyes of infants. The habit is of concern to paediatritians because of the serious toxic effects. 1. To determine how frequent kohl was being used for infants eyes, the reasons for its use and the method of application. 2. To estimate the blood and urine level of lead in infants, and in kohl samples from the local market. 3. To document kohl induced encephalopathy. Mothers of 150 children under a year of age were interviewed and samples of 40 infants' blood and urine were analyzed for their lead content. Kohl was used for 47% of infants. Forty percent of town mothers and 57% of rural mothers were applying it to their infants eyes. Fifty percent of illiterate mothers and 33% of college graduates were applying it. The habit started in the neonatal period: 40% of which on the third day after birth. The reasons for the use were: cosmetic 54%, improving vision 41% and prevention of eye infection 4%. The mean blood and urine levels of lead were higher among kohl user, but it did not reach statistical significance. The lead contents of kohl samples varied from 0.4% to 54%. In two infants encephalitis was present, the most likely cause was kohl use. Kohl use is common during infancy. Its lead content could be high. It was usually applied to the conjunctival side of the eyelid where a higher chance of absorption into the blood stream was expected. Kohl use for infants could lead to encephalopathy. Active means should be adopted to educate mothers about the hazards of kohl use for infants, and possibly banning the sales of lead containing kohl