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Traditional surma eye makeup poses lead risk

June 2010 | Volume 9, Issue 3

Many Pakistani women use surma, an eye makeup also known as kohl, following centuries of cultural, religious and cosmetic traditions. They are unaware the black eyeliner may contain lead, a toxin that can be absorbed through the eyes or via hand-to-mouth contact.

Surma, an ore that is mined and ground into a powder, has been used for centuries as a cosmetic and to ward off evil. Manufacturing is not regulated and lead content varies greatly, from 16 to 70 percent. Many women also apply surma to their infants’ faces, uninformed about its potential to damage every system in the body.

In the first-ever study of prenatal lead exposure in Pakistan, researchers found an association between high lead levels in the umbilical cord and the use of surma. This work was supported by Fogarty’s International Training and Research in Environmental and Occupational Health program.

Photo: Pakistani baby sleeping wrapped in blanket with grey surma eye makeup along eyebrows and forehead
Photo by Rolf D.W. Klemm, courtesy of Photoshare

Surma, an eye makeup that contains lead,
is popular in Pakistan.

Umbilical cord lead levels in Pakistan are very high in comparison to those in developed countries. Prevention or reduction in fetal lead exposure could yield significant public health benefits.

In adults, lead is stored in bones and competes for absorption with calcium. During pregnancy and lactation, when there is an increased demand for the retention of calcium, lead is released from the bones and transfers to the fetus or nursing infant, potentially affecting the child for decades.

Dr. Naveed Janjua and a team of scientists from Aga Khan University, the University of Utah and the University of Alabama at Birmingham examined many factors that contribute to high lead levels in Pakistan. In addition to surma, lead is also present in paint, gasoline, water pipes and smog produced by burning coal and furnace oil.

The researchers have been advocating for action on lead exposure through various groups and initiatives, and are encouraged by coverage of studies on lead in the Pakistani media. Because not all surma is commercially made, they say regulation will be difficult but should be a goal along with efforts to increase public awareness.

More Information


Maternal Nutritional Status During Pregnancy and Surma Use Determine Cord Lead Levels in Karachi, Pakistan. Janjua NZ, Delzell E, Larson RR, Meleth S, Kabagambe EK, Kristensen S, Sathiakumar N. Environmental Research, doi: 10.1016/j.envres.2008.06.004.

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