It is hard being a woman in a society that disapproves of aging women and favors straight hair. In fact, coloring and straightening hair is regarded as “professional,” “good grooming,” or “taking care of yourself.” But at what a cost — a new study shows hair dyes and relaxers are significantly associated with breast cancer…especially for black women.

The Journal of Cancer article showed the results of a study that tracked more than 45,000 women over eight years. Black women who regularly used permanent hair dyes had a 60 percent higher chance of developing breast cancer than black women who did not. White women had an 8 percent higher chance.

Women who used chemical hair straighteners were 30 percent more likely to develop breast cancer. While some white women straighten their hair, in the study three quarters of the black women straightened their hair.

Why the cancer link? The researchers pointed to toxic compounds in hair dyes known as “endocrine disrupters.” This means these compounds mimic hormones and interfere with normal hormone function, thus causing imbalances and an increased risk of cancer.

The chemicals used in products geared towards black women may be more “hormonally active,” according to researchers.

Women are increasingly being encouraged to choose health and longevity over toxic cosmetic options. For instance, a movement is under foot to embrace silver and gray hair and black women are encouraged to embrace their natural hair, with one state so far banning discrimination against black people who wear their hair naturally (many employers discriminate against black women who forgo chemical straightening).

Black women bear the brunt of toxic hair products

Although most commercial women’s hair and body products are laden with toxins, hair products aimed at black women contain a disproportionate amount of chemicals linked with early puberty, obesity, asthma, and cancer.

A 2016 study showed black women’s bodies contained higher burdens of the toxic chemicals found in hair products than in women of other ethnicities.

Researchers have so far identified more than 70 harmful chemicals in relaxers, root stimulators, and anti-frizz products.

Toxins in these products (and in other beauty products in general) have been shown to have the following impacts on health:

• Parabens and phthalates disrupt hormone function and are linked to early puberty and pre-term births.
• Nonylphenol is linked to obesity and cancer.
• Formaldehyde is linked to miscarriage risk and respiratory issues.
• Various compounds irritate the eyes and skin, burn and blister the scalp, damage hair follicles, cause hair loss, and cause respiratory disorders.
• Hair relaxers are linked to uterine fibroids in black girls and women at a rate two to three times higher than in other women. Uterine fibroids affect up to 80 percent of black women during their lifetime.
• Cosmetologists exposed to these products during pregnancy experienced twice the rate of miscarriages.
• Breast cancer is a leading cause of death among black women; they generally have a more aggressive forms of cancer compared to white women.

Just one product alone can contain 30 different toxic chemicals. How these chemicals affect human health when in combination with one another has not been studied.

Toxic hair products could help explain why black women suffer from more endocrine disorders than white or Hispanic women.

While these products harm black women, the Black Women for Wellness Report also points to the complexity and conflict between harmful hair products and the positive role of hair salons in black communities.

Ask my office for advice on how to lower your toxic burden, buffer your body from the effects of toxins in our everyday lives, and improve your overall health and well being.

— Update: 19-03-2023 — cohaitungchi.com found an additional article Common Beauty Procedures That Are Compromising Your Health from the website thyroidpharmacist.com for the keyword hashimoto’s hypothyroidism hai color.

While pursuing thyroid health has been my mission for the past several years, I have always taken pride in my external appearance. Being a full-time mom and running a business has taken over much of the time. I still worry about my looks these days, but I’ve also gained more of an appreciation for how “necessary” certain beauty procedures can be, to keep us looking our best after long nights of very little sleep!

I applaud those who prefer to take a more natural approach to beauty and have learned to love the skin they were born into. But, I do know that many people find that they feel more comfortable when they can address the external issues that are stealing their confidence, such as hair that is slowly graying, or skin that is losing its youthful glow.

However, just as I’ve swapped out all of my personal care products for ones that are safe for my health, I’m always looking for alternatives to many of the common beauty procedures, that won’t compromise thyroid health by exposing the body to harmful toxins.

My goal with this article is to shed some light on the health hazards of some of these common beauty procedures, while, at the same time, offering a few appealing alternatives that won’t compromise your health. It doesn’t have to be all or nothing!

In this article, we’ll explore:

• Common beauty procedures, such as the Brazilian blowout, hair dyeing, breast augmentation, and Botox
• How these procedures can negatively impact your health
• Safer alternatives that still offer results
• Root cause beauty solutions
• Resources for checking the safety of the products you use

The Brazilian Blowout

The Brazilian Blowout, and similar keratin treatments, became popular in Brazil in the mid 2000s, before becoming a hit in Hollywood and the rest of North America. Performed by a licensed stylist, these treatments use a combination of chemical straighteners and a flatiron to straighten and smooth the hair. Results last approximately 3 months, depending on the rate of an individual’s hair growth.

The Problem

The primary concern with this procedure is that it uses formaldehyde in the treatment process. Even treatments that are advertised as “formaldehyde free” have been found to contain as much as 10 percent formaldehyde in the solution. (1) During the heating process, the formaldehyde is released as a gas, which can then be inhaled by both the stylist and the client. For years, stylists have reported that the application of these hair treatments can cause difficulty breathing, eye irritation, and nosebleeds.

Formaldehyde is a colorless, water-soluble gas that has a pungent odor (but this may not always be detectable if levels are low). Short-term exposure to formaldehyde often causes symptoms that mimic signs of allergies, hay fever, upper respiratory infections, colds, or viruses. (2) When formaldehyde is present in the air at levels exceeding 0.1 parts of formaldehyde per million parts of air, some people may experience (3):

• Watery, itchy, or burning (irritated) eyes
• Sore throat
• Runny nose (or nosebleeds)
• Cough
• Headaches
• Nausea
• Dizziness
• Skin irritation

Long term exposure to formaldehyde has been linked to asthma, bronchitis, an increased risk for blood and lymphatic cancers, and impaired brain function. (4-6) Formaldehyde has also been shown to reduce thyroid function, and can trigger an autoimmune response, leading to Hashimoto’s or Graves’ disease. (7,8)

In 2011, the U.S. Department of Health and Human Services added formaldehyde as a known human carcinogen (agents, substances, mixtures, or exposures in our environment that pose a health hazard) to its Report on Carcinogens.

The Occupational Safety and Health Administration (OSHA) has issued a hazard alert for salon employees warning against the use of hair straighteners containing formaldehyde. Other countries (most notably, Canada, France, Ireland, and Australia) have recalled hair-smoothing products containing formaldehyde, based on their own testing results. However, these products are still on the market in the United States.

Safer Alternatives

We all want smooth, shiny hair, right? I know all too well what it is like to deal with hair loss, as well as dry, lifeless hair, as a result of Hashimoto’s. Fortunately, there is a lot that you can do on a lifestyle and nutritional level to restore the luster of your hair.

• Adjust your thyroid medication and optimize your thyroid hormone levels – When TSH levels are on the outskirts of the normal range, hair loss, as well as a lack of luster and shine, can occur. (9) If your hair tangles easily, this is a sign that you may not be producing and absorbing enough thyroid hormone.
• Look for nutrient depletions – I’ve found that nutrient depletions are often at the root cause of thyroid-related hair loss, and also cause hair to be dry and lack shine. Supplementing with iron, biotin, zinc, biosil (which contains a patented form of silicon that supports the body’s production of collagen, elastin, and keratin), and gelatin/collagen can all help boost hair growth and health. (10-13)
• Adjust your diet – Blood sugar swings, a lack of healthy fats, and too few green vegetables can all have a negative impact on hair health. (14,15) To address these issues, stabilize your blood sugar levels by limiting carbohydrates, add plenty of coconut oil and grass-fed meat to your diet, and enjoy a daily green smoothie — you’ll be amazed at the impact these interventions can have on your hair!

Styling Tools and Products

Though the result will only last until the next time you wash your hair, heat styling tools, such as blow dryers and flatirons, can result in hair that is as smooth and straight as a keratin treatment, when used with the proper styling products. The key is to properly nourish your hair with moisturizing shampoos, conditioners and leave-in treatments that don’t contain toxic ingredients, which can cause hair to become dry and damaged over time.

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My favorite hair products that give my hair shine and luster are:

• Acure Organics Moisturizing Shampoo
• Acure Organics Repair Conditioner
• Wellnesse hair products

Before using your heat styling tools, be sure to use a protectant product that shields the hair shaft, in order to minimize heat damage and boost shine. While most commercial heat protectants are formulated with harmful silicons, natural oils act on the hair in much the same way by creating a protective barrier around the hair cuticle. I’ve found that grapeseed oil, almond oil, and shea butter all work well for this purpose and have the added benefits of adding moisture and shine to your hair. All you need to do is smooth a few drops through your hair before using your heat styling tools. Bonus — you can find all of these oils at your local grocery or drug store!

Hair Dye

Whether we’re trying to cover up a few grays, lighten our locks for summertime, or make a bold statement with a whole new look, most of us have experimented with hair dye at one point in our lives. In fact, a 2008 study conducted by Clairol found that 75 percent of American women dye their hair!

Hair dyeing is by no means a new beauty trend. In fact, women have been coloring their hair since the ancient Gauls used lye to lighten their strands, and the Egyptians used henna to brighten theirs. Even as early as the 1940s, hair dye was known to contain ingredients that were questionable to a person’s health, and safety fears kept large numbers of women from coloring their hair. However, with the advent of the first home hair dye kits in the 1950s, hair dye became suddenly accessible and, presumably, safe for the average woman. The number of women coloring their hair on a regular basis has since exploded.

The Problem

Though we’ve moved past the days of using lye and raw bleach on our hair, there are still a number of potentially harmful ingredients that are found in many of the hair dyes on the market today. This is true of both at-home and in-salon dyes.

One of the most problematic ingredients is a chemical called resorcinol. Most commonly found in hair dyes, resorcinol can also be lurking in shampoos, facial peels, and products used to treat acne and other skin conditions.

Health concerns associated with resorcinol include skin and eye irritation, as well as organ system toxicity. (16) It is also an endocrine-disrupting chemical (EDC), and has been shown to interfere with thyroid function by inhibiting the enzymes involved in thyroid hormone synthesis and the activation of thyroid hormone receptors. (17)

Resorcinol is restricted in all cosmetics in Japan, and the EU limits concentrations and requires warning labels. The United States regulates the exposure to resorcinol for workers in certain manufacturing fields, as well as in coal processing (it is a byproduct of coal manufacturing), but not for salon workers.

To avoid this chemical, look for the following ingredients on your product labels: resorcinol, 1,3-benzenediol, resorcin, 1,3-dihydroxybenzene (m-hydroxybenzene, m-dihydroxyphenol).

Safer Alternatives

While many of the hair dyes on the market are filled with potentially harmful ingredients, there are a number of options that are both safe and effective.

• Radico makes organic colors without harsh chemicals, and tests all of their dyes for heavy metals. They are made from natural ingredients without the use of any synthetic chemicals.
• Hairprint restores gray hair to its natural color without the use of dyes. Rather, it deposits eumelanin into the hair shaft, which is a variation of the melanin pigment that is responsible for the color of your skin and eyes. All ingredients are non-toxic and food grade. Though this product only works on brown and black hair, it is perfect for those with chemical sensitivities.

The website Made Safe is a wonderful resource for finding products that are safe for your health. You can find out more about the ingredients to avoid, and search for products that have been certified by their strict vetting process.

Breast Implants

Breasts can symbolize different things to different people — beauty, femininity, motherhood, sexual desirability — and, for at least as long as we have had a written history, women have sought to enhance their breasts for many reasons.

Early attempts at enhancing breasts experimented with everything from injecting liquid paraffin into breasts and implanting glass balls, to transferring fat from the buttocks. However, none of these methods resulted in success until the early 1960s, when two plastic surgeons developed the first silicone breast implants, and an industry was born. (18)

The Problem

Almost as soon as the new silicone breast implants came on the market, women started experiencing a host of complications, including infections, inflammation, and capsular contracture (when a foreign substance is inserted into the body and the body reacts by trying to wall it off by forming a capsule of scar tissue around it). Other complications reported included hair loss, fatigue, loss of sight and hearing, and weight loss. (18)

Even saline implants, which came on the market in the 1990s as a safer alternative to silicone, produced the same initial complications that women experienced with silicone implants: infection, inflammation, rupture, and capsular contraction. (19)

There is a heated debate in the medical community about whether or not breast implants can cause systemic illness, rather than just localized symptoms. However, the number of people who have reported illness reaches into the thousands.

Silicone Immune Disease occurs when silicone leaks outside the shell of the implant. Both the silicone itself, as well as any number of the many chemicals used in the manufacturing process, can make their way into the different systems of the body over a period of years. This can cause symptoms that include fatigue, muscle aches, and brain fog, along with diagnoses of arthritis, chronic fatigue syndrome and fibromyalgia. (20) Since it is well known that exposure to toxic chemicals can result in autoimmune disease, it should be no surprise that when the chemicals present in breast implants leak into the body, an autoimmune disease can result. (21)

Saline Implant Disease, which manifests in women with saline implants, is brought on by biotoxicity, rather than chemical toxicity. (22) Mold and fungus have been found to be present in both the saline fluid, as well as on the valve of the implant itself. (23) These biotoxins can breed in the breast tissue, causing severe muscle and nerve pain in the affected side of the body. But, it can also be released into the rest of the body and cause major disruptions to the endocrine, immune, and neurological systems.

Symptoms of biotoxicity include fatigue, weight gain, constipation, hair loss, dry skin, a deficiency in thyroid hormones, low body temperature, dizziness, weakness, lowered sex drive, menstrual irregularities, sleep disturbances, chronic pain, and leaky gut. (24)

Both the chemical toxicity in silicone implants and the biotoxicity often present in saline implants can trigger an autoimmune reaction in the body that can result in illness, including Hashimoto’s thyroiditis. (25) Those that have a genetic susceptibility to autoimmune diseases will be at particular risk for developing symptoms after being exposed to the toxins present in breast implants.

You can read my full article on how breast implants can be a trigger for Hashimoto’s, as well as one reader’s incredible story of healing after removing her implants.

Safer Alternatives

Fat Grafting

At this time, the most promising alternative to saline or silicone breast implants is fat grafting. This procedure uses liposuction to remove fat from one area of the body (often the buttocks) and inject it into the breast tissue. Though there are limits to the breast size that can be achieved with this method, the results are more natural looking than implants. There is also no risk of allergic reaction, as the procedure uses your own body tissue to fill the breasts.

Drawbacks to this type of breast enhancement include the risk of calcification (hardening of tissue) in the areas of fat injections, and lumps or nodules in the areas of fat removal. (26) The procedure is also more expensive than traditional breast implants, and finding a skilled surgeon can be more challenging. However, with so much scrutiny around the safety of silicone and saline implant devices, fat grafts seem to be becoming a more and more popular alternative.

Breast Pumps

In the early days when my son was first born and I had to pump to stimulate my milk supply, I came across breast pumps for the purposes of breast enlargement. There are a few different devices on the market that are designed to use suction to naturally expand the breast tissue, without surgery or the implantation of foreign material into the body. While this sounds like a winning solution, there is not a lot of research around the effectiveness of these devices, and results vary greatly from person to person.

Breast enhancement pumps work as suction cups — the dome covers the breast, forming a seal. Then the air is sucked out of the space inside the dome, via the pump. This creates suction on the breast, which physically pulls the breast tissue towards the dome. Stretching a tissue stimulates the cells to increase their division rate, deposit more connective tissue between the cells, and expand in the direction in which they were stretched. This concept is called stretch-induced tissue expansion, and is used in a number of medical applications.

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Though studies have shown that these types of devices can produce breast enlargement, there are a number of drawbacks to them. (27) They can be time consuming and cumbersome to use. Though most of the manufacturers recommend using them for 15-30 minutes a day, one study found that participants had to use the device for 10 to 12 hours a day for at least 10 weeks to notice measurable results. For those that do achieve results, breast growth is modest: the average person only sees a maximum increase of one half to one cup size. (27)

That said, this might be a safe and affordable alternative to surgery for those who are looking to boost their breast size. The most popular breast pump devices on the market are:

• BRAVA – This electric breast pump is perhaps the most well-known. It was introduced in the late 1990s after a clinical evaluation of it showed promising results. However, at $2,000, the BRAVA is expensive and can be hard to find these days. If you are considering fat grafting, some surgeons do recommend the use of this device in the weeks preceding the procedure, to enhance results.
• Noogleberry – This hand-pump is an affordable alternative that retails at around $60-80. The company claims that this device can produce results when used for only 15-30 minutes a day, over a period of six to nine months. While there haven’t been any studies to back up this claim, it may be a more accessible option for those looking for a safe and natural alternative to other breast enhancement procedures.

Botox

The anti-aging industry has exploded over the last few decades and, in 2018, was estimated to have a global net worth of 42.51 billion dollars (USD). There are no shortages of products marketed to make us want to hang onto our youth, and while some of these products are relatively harmless (I enjoy a luxurious face cream as much as the next person!), others can have negative consequences to our health.

One procedure that has become ubiquitous with anti-aging over the last few years is Botox. In this procedure, the Botox solution is injected into areas of the face, such as the forehead and eye region. Botox blocks the signals from the nerves to the muscles. With the muscle unable to contract, wrinkles will soften and relax. Results typically only last for three to six months, and the procedure does need to be repeated on a regular basis.

The Problem

Botox is a brand name for the Botulinum toxin, which was approved by the FDA for cosmetic use in 2002. Since then, its injection has become one of the most common cosmetic procedures. However, there have been many concerns raised about potential side effects.

Botulinum toxins are among the most toxic poisons known to humans, with a lethal dose of approximately 1 ng per kilogram of body weight. (28) There are seven serologically distinct types of botulinum toxins. Botulinum toxin A (used in cosmetics treatments) is the most potent serotype, with a toxicity one million-fold higher than cobra venom, and far higher than cyanide!

While there are benefits to using botulinum for specific medical purposes (for example, it can be used to address upper lid retraction issues associated with thyroid eye disease), I view Botox as a toxic foreign body, and do not recommend using it for cosmetic purposes. (29) People with Hashimoto’s need to be especially cautious about toxins, as they are usually triggers for symptoms. In fact, one study did find a possible pathogenic link between Botox and autoimmune thyroid disease. (30)

Safer Alternatives

Though the name is a little scary, the “vampire facial” is a new procedure designed to improve the appearance of the skin, without the risks associated with introducing a toxin into the body.

Also known as a PRP facial, this procedure involves microdermabrasion or microneedling (procedures involving deep exfoliation or needles, designed to generate new skin tissue), followed by an application of PRP (platelet rich plasma) to the facial skin. Essentially, a vial is taken of the patient’s own blood, and the platelets are removed from the serum portion of the blood. These platelets contain high levels of growth factors, which stimulate cell turnover when applied to the skin. This increases collagen and elastin in the skin, while also infusing the skin with antioxidants and hydration. (31)

While it might sound a little gruesome, the procedure is actually quite safe. The only risk is a little bruising in the blood draw area. In fact, PRP is an exciting new procedure that is being used for everything from hair regrowth, to healing damaged bodily tissues. It allows the patient to avoid risky surgeries and harmful toxins. Instead of introducing foreign substances into the body, it is only the person’s own blood that is being used.

Though the procedure isn’t cheap (average costs are around $1,000), a vampire facial is a much safer alternative to Botox, and produces similar results: minimized fine lines, reduced sun damage, and an overall fresher appearance to the skin.

Root Cause Beauty Solutions

There’s no shortage of procedures, products, and treatments to improve the appearance of our skin, but let’s not forget that what’s going on inside our bodies is reflected on the outside. In addition to swapping out toxic procedures with safer alternatives, if your goal is radiant, glowing skin, one of the best places to start is to take a look at what’s going on inside with your hormones, your gut, and your diet.

Acne, dry skin, rosacea, eczema, and premature aging can all be tied to our diet, our hormones, and the state of our gut. (32-36) We can apply as many topical treatments as we want, and they may help to a certain extent, but these problems are likely to persist until we get to their root cause!

There are many hormones at play in women’s bodies, and it’s essential that they’re in balance for optimum energy, health, and vibrant skin. These hormones include estrogen, progesterone, testosterone, thyroid hormones, DHEA, cortisol, insulin, and others. When our hormones are off (as is so common with Hashimoto’s), this imbalance can cause acne, dry skin, melasma, and other skin complaints (not to mention a host of other symptoms!). (32,33,37)

If you’ve been working to get the root cause of your Hashimoto’s, then you know how important the gut is in this process. The state of our gut is just as important for skin conditions as it is for optimal digestion and nutrient absorption. Just like we have a gut microbiome, we also have a skin microbiome, and they are intimately connected. (38) Our skin microbiome plays a part in the natural lipid barrier and skin immune system, which promotes vibrant looking skin. (38) If you’re looking to support your skin from the inside out, healing your gut is a good place to start.

Of course, the foods we eat also play a large part in the health and appearance of our skin. When our food is rich in antioxidants, collagen-boosting nutrients, and healthy fats, it supports radiant skin (not to mention it also supports our hormones and our gut). (36) By cutting down on processed foods and sugar, and including plenty of fresh, whole foods into our diet, we’ll be giving our skin the building blocks it needs to stay healthy.

My friend and colleague, Dr. Trevor Cates (you may know her as “The Spa Dr.”), just came out with a book all about this, and I’m so excited to share it with you! In Natural Beauty Reset: The 7-Day Program to Harmonize Hormones and Restore Radiance, Dr. Cate’s provides you with tons of information on hormones, gut health, and toxins, along with diet, mindset, movement, and product recommendations to support glowy skin and overall wellness.

As a proponent of living in accordance to the seasons, she has created a 7-day reset for every season, with modifications to balance your hormones using four key aspects for lasting beauty that glows from the inside out:

• Food
• Movement
• Mindset
• Skin care

The book also contains 80+ food and DIY skin care recipes to help you on this journey, as well as lifestyle practices and exercise recommendations to support optimal health, and of course, the health of your skin!

If you experience skin concerns like acne, dry skin, rosacea, eczema, and premature aging, and would like a guide to revitalized health and balanced hormones using a root cause approach, I highly recommend checking out Natural Beauty Reset.

The Takeaway

While there are a number of potentially harmful chemicals in many of the beauty products and procedures on the market today, it’s not necessary to forego all beauty treatments in the name of good health. As the risks of some of these procedures are becoming more widely understood, safer and effective alternatives are becoming more available.

Whether you are looking to rejuvenate your skin, brighten up your hair color, or enhance your bra size, I encourage you to put your health first, do your research, and find products and procedures that will allow you to enhance your natural beauty… while protecting your thyroid from harmful chemicals.

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For more information on choosing personal care products that won’t harm your thyroid health, take a look at my article on sacrificing health for external beauty.

If you’re looking to dig deeper into the ingredients in your personal care products, the Environmental Working Group’s Skin Deep database, Campaign for Safe Cosmetics, and Made Safe are all great resources for checking the ingredients of the products you are using and discovering safer and more natural beauty care options.

I also encourage you to consider a root cause approach and support your natural beauty from within! 🙂 Dr. Cate’s new book, Natural Beauty Reset, is a whole-body action plan that can help you get started!

As always, I wish you success on your journey to being well!

P.S. Be sure to sign up to my weekly newsletter to get a free chapter from my first book, recipes, my Thyroid Diet Quick Start Guide, notifications about upcoming events, and my latest research. For future updates, make sure to follow us on Facebook and Instagram as well!

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— Update: 19-03-2023 — cohaitungchi.com found an additional article Hair dyes as a risk for autoimmunity: from systemic lupus erythematosus to primary biliary cirrhosis from the website www.ncbi.nlm.nih.gov for the keyword hashimoto’s hypothyroidism hai color.

Introduction

Environmental factors combined with genetic susceptibility are largely believed to be essential working partners in the development of autoimmune disease [1–4]. The term ‘environmental factors’ or ‘environmental agents’ in the discussion of the pathogenesis of autoimmune disease, is a blanket term to address environmental components such as microbial agents, vaccines, diet, drug exposure, heavy metals, ultraviolet radiation and smoking, among many others [3–9]. Monozygotic concordance rates below 50% are indicative that environment as well as genetics are involved [10–13]. As well, studies on genetically similar populations living under different conditions have demonstrated different incidence rates of autoimmune disease. The induction of autoimmune disease by these exposures may be through various mechanisms such as the alteration of autoantigen structure, altered expression of antigens, stimulatory effects on the immune system, T-cell dysregulation, apoptosis-mediated autoimmunity, molecular mimicry and immunological cross-reactivity [5, 14–18].

Cigarette smoking is one example of non-infectious agents which have been studied in rheumatoid arthritis (RA), autoimmune thyroiditis, inflammatory bowel disease, and primary biliary cirrhosis (PBC) [19–22]. Cigarette smoke has been shown to increase the production of pro-inflammatory cytokines, and reduce the levels of anti-inflammatory cytokines. Free radicals contained in cigarette smoke can provoke cellular destruction and release of intracellular autoantigens. Various toxins found within cigarette smoke may cause DNA damage and genetic mutations, as well as stimulate autoreactive T cells [21]. An alteration in oestrogen metabolism, which has been indicated as a feature in autoimmune disease, has also been found to occur in active smokers [23, 24]. However, the effect of tobacco smoke in the loss of self-tolerance may be more complicated, as it appears that smoking abstinence exacerbates gastrointestinal symptoms in patients with ulcerative colitis (UC). Such an effect has not been noted in patients with Crohn’s disease, the other major inflammatory bowel disease.

Silica exposure has also been investigated as a factor involved in autoimmune disease [12, 25, 26]. Silica has been linked with scleroderma, RA, vasculitis and systemic lupus erythematosus (SLE) [12, 25, 26]. Silica acts as an immune stimulant, increasing pro-inflammatory cytokine production, as well as inducing apoptosis and necrosis [12, 25, 26]. Interestingly, silica has also been shown to increase autoantibody production [27] and immune complex formation in animal models. Animals exposed to silica have demonstrated increases in B and CD4 T cell counts, as well as altering T helper and T regulatory cell ratios [28]. Apart from silica, exposure to solvents such as trichloroethylene, mineral spirits, and petroleum based products have been linked to scleroderma and other undifferentiated connective tissue diseases [29].

Primary biliary cirrhosis is one autoimmune disease in which multiple environmental factors have been implicated. Hair dyes have been added to this list, but very few studies address these compounds. Hair dyes have been previously explored in relation to SLE, both epidemiologically and immunologically. This review will examine the literature surrounding the use of hair dyes in SLE in relation to PBC. As PBC and SLE very rarely co-occur in an affected individual, the effect of hair dyes in either disease may help us understand the complex role of these compounds as environmental triggers of autoimmunity.