Introduction
In the 1970s, a prominent actress sought to aid the resettlement of Vietnamese refugees by running a vocational training program, spurring a “butterfly effect” that would create the modern American nail salon. People who immigrated from Vietnam—beginning with the twenty women who received the actress’s manicure training—gradually and significantly transformed the nail salon industry. What once was an unaffordable and unattainable experience available only to elites blossomed into an “affordable luxury” for many Americans. As manicures, pedicures, and other nail design services become increasingly popular, customer demands continue to bolster the booming industry; in fact, between 2014 and 2019, the number of U.S. nail salons doubled. Even with strict government-imposed health and safety precautions at the height of the COVID-19 pandemic, nail salons have successfully rebounded to meet customer demands. Today, the brick-and-mortar nail salon industry is worth over $8 billion and is expected to continue to grow over the next decade.
But behind this veil of prosperity, nail salon technicians face occupational hazards from the nail products that they must use in the scope of their work. These products can contain dozens of chemical vapors. The effects of these harmful vapors are magnified by their day-to-day use for long hours in salon. As a result, nail technicians experience chemical exposure intensities 1,200 times that of the average American. They inhale ten times more flame-retardant and plasticizer chemicals than the average electronic-waste facility employee. Levels of cancer-causing chemicals in nail salons can even exceed those in auto garages. For many nail technicians, these chemical exposures manifest in short-term dermal and respiratory irritation. For others—including still unknown future victims—exposures manifest as long-term debilitating health outcomes like cancer, asthma, and reproductive issues. Today, Vietnamese-American nail technicians—the same population credited for forging the modern, archetypal American nail salon—experience up to twice the level of phthalates (reproductive toxicants) in their bodies compared to the general Asian-American population. The modern nail salon industry suffers from an “epidemic of health issues” caused by chemical exposures. The risks from those exposures are exacerbated because this workforce is largely comprised of women of Asian descent who immigrated to the United States with limited English-speaking proficiency and who experience a lack of access to “culturally and linguistically appropriate educational and outreach materials.”
Yet despite these risks, the industry continues to thrive. For many nail technicians, these exposures are just part of earning a living in an industry that appeals to their unique employment needs. Further, the nail salon industry comes with its own set of exploitative practices. Nail technicians are “frequently underpaid, overworked, and misclassified as independent contractors instead of employees.” Without the safety net of labor protections, nail technicians face barriers to issuing formal complaints and filing workers’ compensation claims over safety hazards in the workplace.
Occupational safeguards fall short of protecting nail technicians. While the Occupational Safety and Health Administration (OSHA) sets “permissible exposure limits” for chemical air contaminants found in nail salons, OSHA has recognized that the limits “are outdated and inadequate for ensuring protection of worker health.” Additionally, although OSHA recommends against using products that contain harmful chemicals in the workplace, it does not restrict nail salons from using products containing these ingredients. Ultimately, occupational guidance and regulations shift the burden of worker safety onto private nail salons, ninety percent of which are small businesses without designated safety personnel. This demonstrates a need for regulatory action at the source: the manicure products themselves. However, the level of cosmetic product oversight is grossly incongruent with the cosmetic industry’s success.
In 1938, Congress passed the Federal Food, Drug, and Cosmetic Act (FDCA) after years of industry resistance. In doing so, Congress intended to replace the 1906 Pure Food and Drug Act and, for the first time, enable federal oversight of cosmetics to safeguard consumers from dangerous beauty products. But the cosmetics regime soon proved to be insufficient in reining in dangerous products, and, over the next several decades, industry players successfully quashed numerous attempts to reform cosmetic ingredient safety. The cosmetics industry continues to reap the benefits of a weak regulatory landscape: since the 1970s, the industry has funded and controlled the “only panel tasked with determining the safety of individual cosmetic ingredients.” The industry’s self-regulation reveals a dismal truth for both consumers and salon workers: despite the beauty industry’s increasing use of chemicals in cosmetics, manufacturers today are still not subject to any Food and Drug Administration (FDA) pre-market ingredient review or approval.
Despite a recent legislative overhaul of the FDCA that altered the cosmetic regime for the first time in over eighty years, FDA still lacks the authority it needs to restrict the use of harmful chemicals in nail products. As studies of long-term effects of chemical exposures in the nail salon workplace remain few and far between, workplace protections continue to be underregulated; legislation and regulations must address manicure product safety to ensure that this vulnerable group is able to prevent debilitating health effects before it is too late.
Part I of this Comment examines the most pervasive nail product chemicals and their potential effects on occupational health. Part II evaluates how FDA’s rigid cosmetic framework limits the agency’s pre-and post-market authority and prevents it from addressing nail product safety issues through traditional enforcement powers. Part III analyzes the permissible extent of FDA rulemaking on nail salon product chemicals. Part IV analyzes how current trends in jurisprudence may affect FDA’s authority to protect professionals (rather than just consumers alone) from harmful chemicals in nail products. Part V examines recent cosmetic reform and discusses provisions necessary to protect nail technicians through ingredient review, using an Environmental Protection Agency (EPA) chemical ingredient reform as a blueprint. Part VI recommends two possible remedies through either legislative action or FDA rulemaking.
I. Toxic Chemicals, Poisoned Workers
A. Toxic Chemicals
Each day at work, nail technicians can encounter dozens of chemical constituents in the products necessary to perform their jobs. The most notorious example of harmful nail product ingredients is the “toxic trio,” a combination of dibutyl phthalate, formaldehyde, and toluene. Like many other chemicals in nail care products, components of the toxic trio have been linked to a variety of negative health outcomes through inhalation and dermal contact. Formaldehyde is a nail polish hardening agent that causes difficulty breathing along with skin, eye, and nose irritation. Formaldehyde is also a known human carcinogen. The FDA-supported, industry-operated Cosmetic Ingredient Review (CIR) panel concluded in 2012 that formaldehyde is “safe in the present practices of use and concentration in nail hardening products,” despite acknowledging that at “high doses” formaldehyde can cause nasopharyngeal cancers—the report ignored potential long-term accumulations that technicians may experience.
Dibutyl phthalate (DBP) is a nail polish bonder that, in the short term, causes nausea and skin, eye, and nose irritation. In the long term, DBP is a reproductive toxin linked to birth defects and endocrine disruption in animals. However, based on research last updated in 2002, FDA did not find a “sound, scientific basis to support taking regulatory action against cosmetics containing phthalates.”
Toluene is an organic solvent added to nail polish for a smoother application. Toluene has also been linked to spontaneous miscarriages in occupationally-exposed women. The CIR panel last reviewed toluene in 2005, finding that “adverse effects occurred only at levels many times higher than those observed when people used nail polish.” The CIR panel did not consider toluene’s effects at levels that nail technicians experience—instead, it concluded that “high exposures . . . are not relevant to the use of toluene in cosmetic products.”
In attempts to market their products as “3-free,” some manufacturers substitute out the toxic trio for chemicals such as triphenyl phosphate (TPHP) and didiethylhexyl phthalate (DEHP). TPHP, a plasticizer and flame-retardant commonly substituted for DBP, has been linked to reproductive toxicity and endocrine disruption. DEHP, a chemical banned in the European Union, is a hormone disrupter and possible carcinogen.
Overall, few studies examine nail product chemical exposures and adverse health outcomes in nail technicians, resulting in limited scientific research on the subject. The shortage is partially due to a diversity problem: members of nail technicians’ ethnic and cultural community are not well-represented in the research community, so “the people who care about [nail technicians] most [are not] . . . involved in addressing the problems.” The shortage of studies fails to reflect the serious concerns nail technicians have relating to the negative health outcomes associated with exposures to chemicals in nail products.
B. Poisoned Workers
In 1988, Le Thi Lam immigrated to the United States from Vietnam. Soon after becoming a nail technician, she developed asthma and a thyroid condition. Ailing and concerned about the chemical exposures from nail products, Lam left the nail salon industry, but she returned after failing to find another job. Years later, she learned that she had breast cancer.
After immigrating to New York from Nepal, Pabitra Dash became a nail technician. Her relatives told her that “for immigrants like [them], working in a nail salon was the best choice.” Dash worked in the nail salon for years, where she inhaled chemicals such as toluene and formaldehyde. She just “wanted to survive and eventually start a family”—instead, over the course of ten years, Dash suffered seven miscarriages.
Dr. Charles Hwu, an internist in Flushing, New York, routinely encounters a particular set of conditions affecting otherwise healthy young women:
They come in usually with breathing problems, some symptoms similar to an allergy, and also asthma symptoms—they cannot breathe . . . . Judging from the symptoms with these women, it seems that they are either smokers, secondhand smokers or asthma patients, but they are none of the above. They work for nail salons.
These stories are not unique, and these women are not alone. The limited medical studies that do exist illustrate a pervasive set of ailments distinctive to nail product chemical exposures, often finding that nail technicians suffer from respiratory, skin, and musculoskeletal issues as a result of exposure to the “laundry list” of chemicals they encounter daily.
Beyond the short-term ailments, studies hint at more insidious illnesses emerging from long-term exposure. Over a twenty-year exposure to manicure products nail technicians are over one hundred times more likely to develop leukemia due to formaldehyde exposures and are up to thirty-eight times more likely to develop mouth and throat cancer due to benzene exposures. By contrast, it is highly unlikely that nail salon customers will face exposure to a significant or harmful concentration of manicure product chemicals—after all, consumers only spend a fraction of the time in nail salons that technicians do. Therefore, special product safety considerations are needed to account for the exposure levels that nail technicians face.
II. Traditional Powers Under FDA’s Rigid Cosmetic Framework
A. FDA’s Limits to Pre-Market Evaluation
FDA does not possess the requisite pre-market authority to regulate chemicals in nail care products. Unlike under the FDCA’s drug, device, or additive approval processes, manufacturers do not need ingredient approval from FDA before distributing cosmetics in interstate commerce. Rather, the cosmetics industry itself is responsible for pre-market safety assessment through the CIR panel, an industry-funded mechanism that examines voluntary, manufacturer-provided data to make non-binding conclusions regarding product safety. Since its inception in 1976, the CIR panel has only analyzed eleven to thirteen percent of all cosmetic ingredients and has only found eleven unsafe chemicals out of the 10,000 used in cosmetics. Additionally, some believe the industry-funded findings pose a conflict of interest and question the impartiality of the CIR panel. This ambivalence toward current ingredient safety determinations demonstrates a need for FDA to obtain its own independent ingredient review authority.
FDA could improve pre-market product safety but has failed to define testing or evidence requirements for safety substantiations. Under FDA’s regulations, ingredients in cosmetic products “shall be adequately substantiated for safety prior to marketing” or otherwise bear a warning label stating that “the safety of this product has not been determined.” FDA directs manufacturers to rely on “available toxicological test data” or conduct tests to assess ingredients and formulae for safety, but does not specify exactly what records manufacturers must provide to show such substantiation. As long as a scientist can “reasonably conclude” that the product is not harmful through its intended use or foreseeable misuse, manufacturers can market the product without the prescribed warning label, regardless of the kind of tests conducted or data provided. Cosmetic manufacturers are not required to provide specific research to demonstrate ingredient safety or share their safety information with FDA before distributing their products in commerce.
Recent developments could scale back FDA’s already limited pre-market oversight of cosmetics. In December 2022, Congress passed the Modernization of Cosmetics Regulations Act of 2022 (MOCRA) as part of the Consolidated Appropriations Act of 2023. MOCRA requires manufacturers to ensure there is “adequate substantiation of safety” of their cometic products. MOCRA defines an “adequate substantiation of safety” as tests or evidence that qualified scientific experts would believe are sufficient to support a “reasonable certainty” that a cosmetic product is safe under its “customary or usual” conditions of use.
Like existing FDA regulations, MOCRA does not specify the standards for tests that manufacturers must maintain or conduct to demonstrate safety. Rather, by providing that manufacturers need only demonstrate cosmetic safety under “customary or usual” usages—despite current FDA regulations requiring the additional consideration of “reasonably expected related uses”—MOCRA codifies an even weaker safety expectation for cosmetics in the market. Therefore, MOCRA “appear[s] to supersede” FDA regulations with reduced standards for cosmetic safety substantiations that manufacturers must provide prior to marketing. Ultimately, by failing to offer uniform testing and evidence standards for manufacturer safety substantiations, FDA effectively enables manufacturers to downplay the risks associated with certain chemical ingredients before marketing their cosmetics.
B. FDA Post-Market Enforcement Authority: Misbranding
In the cosmetic labeling space, FDA derives authority from both the FDCA and the Fair Packaging and Labeling Act. Under both Acts, anything on or accompanying a cosmetic product’s package constitutes labeling. A cosmetic is misbranded if “its labeling is false or misleading in any particular,” and FDA may issue warning letters or, with assistance from the Department of Justice, seek injunctions or criminal penalties against manufacturers for introducing misbranded cosmetics into interstate commerce. Despite its authority to prohibit misbranded products in interstate commerce, FDA has not addressed common claims from nail care product manufacturers that feign product safety. Although MOCRA requires products intended for professional use to bear ingredient listings, users might rely on marketing claims instead of unwieldy and confusing ingredient lists.
Federal law provides that in determining whether a label is misleading, the agency will consider the extent to which the labeling “fails to reveal facts material . . . with respect to consequences which may result from the use of the article.” For example, FDA has utilized this provision in the cosmetic context before to find that a hair product containing methylene glycol, a liquid that becomes formaldehyde gas when heated, was misbranded because the manufacturer labeled it as “Formaldehyde Free.” Similar practices exist in the nail product industry. In 2012, the California Department of Toxic Substances Control sampled twenty-five different nail polish brands for the presence of the toxic trio. Out of the twelve products that claimed to be free of toluene, ten contained detectable concentrations of the chemical, and five of the seven products claiming to be free of DBP, formaldehyde, and toluene were falsely labeled. While this practice could make for a misbranding offense, other industry labeling practices raise novel concerns.
In addition to “free-of” claims, manufacturers also use “number-free” (n-free) labels that claim to exclude certain ingredients but consequentially shield the substitution of other harmful chemicals in their formulations. These claims, which can range from 3-free (free of three harmful chemicals) to up to “13-free” (free of thirteen harmful chemicals), may claim to be free of materials not traditionally even used in nail polish. Not only do different brands of nail products define label contents differently from one another, more recent n-free claims are often inconsistent with the list of ingredients excluded on previous labels of the same product. The lack of regulatory scrutiny applied to these inconsistencies blurs the line between acceptable, safe ingredients and unacceptable ingredients, subjecting nail technicians to potential harm.
While falsely claiming the absence of an ingredient on the cosmetic label violates misbranding regulations, it is unclear whether FDA may take a similar approach to nail product n-free claims and subsequent substitutions with other harmful chemicals. For example, while methylene glycol in hair products becomes formaldehyde, the same cannot be said for toxins such as TPHP, which is substituted for DBP. To address the ambiguity of labeling in light of the practice of “continual substitution of toxic chemicals for other toxic chemicals,” FDA should provide clear n-free chemical list definitions that include common substitutions known to be harmful to health. Without providing these definitions, FDA precludes consumer suits seeking to hold manufacturers accountable for misleading claims because courts are highly deferential to the agency’s interpretations of labeling terms. FDA is the agency best suited to prevent nail care product manufacturers from continuing to craft their own, inconsistent standards for safety claims.
C. FDA Post-Market Enforcement Authority: Adulteration
Under the FDCA, a cosmetic is an article that is “intended to be . . . applied to the human body . . . for . . . beautifying . . . or altering the appearance.” Under the FDCA’s adulteration provisions, a manufacturer may not use “any poisonous or deleterious substance” that makes a cosmetic “injurious” when it is used as intended, meaning when it is used according to directions on the label, or in the usual or customary way. Introducing an adulterated product into interstate commerce may subject an individual or manufacturer to criminal penalties.
The FDCA’s “intended for use” scope in these definitions effectively precludes safety considerations for nail technicians. For nail care products specifically, FDA assumes that otherwise harmful ingredients are safe when used on the nails because “the nail is a barrier, which prevents absorption.” For nail products, an intended use does not encompass contact from inhalation or dermal absorption. However, nail technicians cannot escape exposures that fall outside of the intended-use scope. Due to this statutory rigidity, FDA appears powerless to act on chemicals in nail care products when such chemicals are harmful through uses that the statute does not consider but that naturally follow from it.
FDA has provided unclear interpretations for whether products containing chemicals exposed through unintended contact, such as under the conditions such products are used in the salon setting, are subject to adulteration actions. In 2011, FDA warned a manufacturer of hair smoothing products that its merchandise was adulterated because it contained harmful levels of formaldehyde gas, for which the “primary route of exposure . . . is through inhalation,” although the product’s intended use was not for salon workers or clients to inhale. Since FDA explored expanding on its interpretation of the statutory definition in the context of hair products “primarily for use by salon professionals in a salon setting,” there may be opportunities for the agency to act under its current adulteration authority. This ambiguous space requires clarification to unequivocally answer whether FDA can enforce adulteration provisions on harmful products with chemicals that nail technicians inhale or make dermal contact with during the application process and whether such contact is “customary or usual.”
Furthermore, a cosmetic is adulterated if “it consists in whole or in part of any filthy, putrid, or decomposed substance.” The statutory language of “putrid” and “filthy” connote acute, immediate risks rather than risks from the long-term exposures that nail technicians face. However, recent developments under MOCRA provide that FDA can “consider, as appropriate and available, the cumulative or other relevant exposure to the cosmetic product” in deeming that a cosmetic is adulterated because it has not been adequately substantiated for safety. Because this provision is both unprecedented and optional for FDA, it is unclear whether the agency will use it to address nail product safety. Otherwise, absent a meaningful showing of harmful long-term effects—a showing that can be difficult to demonstrate—cosmetics such as nail products could remain on the market despite containing ingredients that are hazardous when they accumulate.
FDA also affirmed that it can take action towards ingredients within its regulatory framework for cosmetics “based on reliable scientific information available” to it. However, it is unclear whether FDA can accept existing research on nail product safety as adequate “reliable scientific information” for it to pursue an adulteration action. Given that FDA has not provided the standards for the kind of information that surpasses the action standard, the extent of FDA’s ingredient review authority in this area necessitates more clarity.
Out of over 10,000 ingredients used in cosmetic formulations, FDA has only banned or restricted eleven ingredients that render cosmetics adulterated. Compared to the nearly 2,000 substances that the European Union has banned from cosmetics, the brevity of FDA’s restriction list demonstrates that the process of banning an ingredient in the United States is not straightforward. Even with evidence that an ingredient is harmful to human health, the road to banning a harmful ingredient is fraught with bureaucratic roadblocks and is vulnerable to leadership changes. Prior FDA attempts to ban harmful cosmetic ingredients demonstrate that FDA may abandon the efforts due to shifting priorities or other unrelated issues despite “dozens of complaints,” findings that an ingredient endangers salon workers, and scientists “mak[ing] the case for restricting” the use of an ingredient. Among the unclear regulations, manufacturer indifference, and institutional infighting, the true victims are the salon workers who remain at risk of harmful product effects until FDA bans chemical culprits.