Summer 2019 Resolutions

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This is a bit different! I thought this would be a fun post to make. Resolutions aren't just for the new year! As I am officially off university for the summer, despite a couple commitments here and there, I decided to make a list of things I wanted to accomplish before the start of the next school year.   It will be fun to update you guys as it seems that blogging tends to motivate me more given that it acts as a form of accountability. 

Get fitter.  I am determined to stick to working out as I write this.  My aim is to exercise at least 1 hour a day doing HIIT (Insanity of course and then move on to Insanity: The Asylum) and 1 hour of dance training (Kathak and hip hop especially).  Since my days are mostly free, I have no excuse.  All I need is more dry shampoo and deodorant.

Work on my styling portfolio.  I haven't put my certificate to as much use so I would like to put more effort into building up a fashion portfolio and posting more outfit of the days on my Instagram. I am hoping to do more freelance work in the coming years.

Learn to do a front flip, backflip, and splits.  I always admired gymnasts but my parents never had the funds growing up to put me in tumbling classes.  Nonetheless, never say never.  This summer I aim to get more flexible and eventually build up strength and technique to do a backflip.  I also feel these elements would add a different flare to dance routines.

Go over this years' university material.  It is important that I relearn this years material as our exams are cumulative. Therefore, everything taught in semester 1 and 2 can be tested in semester 3, 4, etc.  Thus, revisiting the material in a stress free mentality (not for examinations) over summer would prove beneficial.

Release note bundles on my Etsy.  I already have two, but I want to release at least five more note bundles onto my Etsy for other individuals or healthcare professionals to utilise.  The note bundles I aim to release are: cardiovascular system, musculoskeletal system, haematology, metabolism, endocrinology, infection, and pathological processes.

Wake up early.  Prior to my exam results, I was soaking up the peace of just sleeping in and not worrying about revision (despite the re-occurring dream that I missed all my tests).  Now I am determined to wake up early and make it more of a natural habit.

I'll post an update on how my resolutions are going in a months' time, and it would be interesting to see what I've achieved.

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Curating your Dream Wardrobe

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Building your dream wardrobe can be an overwhelming task.  Recently, I cleared out 75% of my clothes because I found my closet to be cluttered with pieces I no longer had an affinity for.  It was a refreshing experience to detox and realise what my newfound style is.  Now, I can see all of my garments for various occasions. Through this process, I realised a few important considerations one should make when decluttering and curating their dream wardrobe.  No wardrobe is built over night, it is a procedure that takes time.  It would be unrealistic and financially straining to do a complete makeover in a short span of time. 

Detox. Here is a blogpost I did a few months ago on how to clean and sort your clothes in 3 easy steps: click here for more. Cleaning out your existing closet is a major step in curating your dream wardrobe.  It enables you to visualise what you have, what you do not need/want, and what you need.  This emphasises the importance in shopping with intention (a.k.a knowing what exactly you are looking for) and prevents cluttering in the future.

Categorisation.  Your wardrobe should cater to your lifestyle.  Garments should fall under the following general categories: 
  • Loungewear/Pyjamas
  • Workwear/Office Wear - Regardless of your job or if you are still in school/university, having formal clothes is useful for interviews, conferences, business events, etc. 
  • Everyday - These are pieces you want to wear to university, school, shopping, running errands, etc. 
  • Work out outfits - You only need 3 pairs for the week depending on how often you do laundry
  • Occasion wear - I have occasion wear for formal events such as balls and dances, and also south-asian wear such as anarkalis, salwar kameez, saris, etc.  
When buying garments, ensure that it suits your lifestyle.  For example, there is no need for me to purchase tennis skirts, hiking gear, or gloves for lifting heavy weights because that does not fit my day-to-day life.  But for others, these pieces are necessary and worn daily.  This guarantees that you have clothes various occasions; saving money in the long run.  Purchasing prom dresses the day before the event can break the bank (speaking from experience). 

Buy in Outfits.  In the past, I would buy random pieces that did not go with anything previously present in my wardrobe.  This meant I had to snap up more attire which isn't financially viable or they collect dust in the back of my wardrobe as I'm unable to wear it. Now, when I shop, it's crucial that I have complimenting garments or purchase an outfit instead of random articles of clothing.  Having an outfit ready as soon as you walk out of the store makes sifting through your wardrobe that little bit easier. 

Do not buy in bulk. It is very tempting to go on a shopping spree and admire your new wardrobe.  By all means, if you have the money to do so, you do you! However, most individuals may be apprehensive.  Fashion is fast. It changes every day, let alone every season and year.  There will be new material in stock that may catch your eye. It is preferable to buy a couple garments every few months.  As aforementioned, curating your dream wardrobe takes time and is a journey to be embraced. 

Themes. Having a theme ensures your wardrobe is more cohesive.  Forming outfits will be an easier task. A theme doesn't have to equate to a particular style.  Rather, it involves embracing ideas of a capsule wardrobe where multiple pieces complement and work well together.  We have all suffered with 'I don't have anything to wear Syndrome' where an underlying symptom is a closet full of clothes.  Having a theme will help prevent this issue. The existing themes in my wardrobe are:

  • Colours: pink, beige, stones, neutrals
  • Patterns: florals, printed statement skirts, and embroidery
  • Textures: tweed and boucle
If you are unsure of what themes you may be drawn towards, using resources as simple as Pinterest or fashion bloggers is a great way to decipher your personal style and preferences. 

Quality not quantity. In the past, I would strictly shop at cheaper stores in an effort to have more options in my closet.  Nonetheless, quantity does not mean more options because the pieces could be cheap, rip easily, or simply be bought in bulk and not go with anything you own! 

On the other hand, quality does not mean high-end and designer.  Rather, it is being more vigilant that the products you buy are long-lasting and appear rich.  You do not have to spend more money in an effort to achieve quality.  Many high-street brands such as TopShop, Dorothy Perkins, and even Primark have produced high quality garments that I wear to this day despite buying them many years ago.  Lastly, having higher-quality goods will make you feel and look more put together. Many online outlets allow you to access past-season designer or high-end wear for high-street prices such as MandMDirect and BrandAlley. 

In essence, those are my steps to curating your dream wardrobe.  It does not happen over night.  It is a slow burner. Saying that, it is extremely satisfying to see your closet grow to fit your needs, wants, and taste.  There isn't a day I struggle to find something to wear that makes me feel confident.  Life is too short to not feel like a million dollars! 








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How I study Anatomy

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Hello everyone!  The anticipation waiting for my exam results has resulted in my inactivity but, by the grace of God, I have passed my first year of medical school.  Therefore, I felt that it was appropriate that I shared my methods of learning anatomy as it can be an arduous task figuring out what study techniques and resources are the best aid without breaking the bank.  




Resources 

Google. More than textbooks, my biggest resource was simply google images of pro-sections that were fully labelled.  If your exam includes an element where you will have pro-sections that you need to discuss/label, then this is a very vital way to learn.  Unfortunately, the human body is more mono-toned and muscles/nerves/arteries tend to look like spaghetti.  Thus, getting use to labelling parts in a pro-section will aid your learning far more.  

Netter's Flashcards - £26.94Despite flashcards being the most effective learning method, I can be quite lazy at utilising them.  Making the flashcards itself is what drains a lot of time.  Hence, these anatomy flashcards were perfect for me.  Not only does it have the body parts labelled, it discusses their purpose, insertion/origin, and common clinical conditions associated with that specific part.  These cards permit access to an online flashcard deck with questions and answers to facilitate your studying.  It saves you a lot of time in the long run and you can get stuck right in with learning! This is a fantastic memorisation aid. 



Complete Anatomy 2019.  I was blessed that my university actually equips medical students with an iPad and discount codes for this application.  However, I am aware that this is a luxury many cannot have.  If you have a smart phone or tablet that can support the app, I do recommend considering complete anatomy.  During the semester, I used this app frequently to consolidate my learning but during revision I mainly focused on the flashcards, pro-section pictures, and lecture notes.  This app is perfect at gaining a better understanding on particular insertion and origin points of tendons, muscles, etc. alongside memorising and visualisation about each part's location.

It must be surprising that I didn't mention any specific textbooks.  Personally, I did not use a textbook for my exam revision because sometimes there can be a surplus of information present that you do not need for your exams, but do require to consolidate understanding.  A textbook that I do refer to is Gray's Anatomy Student Edition which is a simplified version of the original textbook. It is more concise and the language is easier to follow in comparison. 

Revision techniques

Repetition repetition repetition.  I cannot emphasise the importance in revisiting the material you learnt in anatomy.  A majority of it is rote learning and memorisation above everything else.  Most of my revision techniques discuss how you can increase your memorisation power in the context of anatomy.  Thus, for this tip, make sure you try to keep up during the semester or if that fails, give yourself enough time to revise anatomy thoroughly.  

Teach the material.  As everyone says 'your ability to teach others dictates how well you know the material yourself'.  I will either teach my mother, talk out loud to myself, or teach my stuffed animals (who are now very intelligent).  It is a fun and great way to self-assess how much and how well you know the information.  

Use your own body. Online, there is a wealth of resources that demonstrate how we can learn the dermatomes and myotomes for example, through various movements.  In the exam, don't hesitate to move subtle movements with your body (plantar flexion, finger hyperextension, etc.) to jog your memory. Obviously, try to be discrete as you do not want the exam invigilators to get suspicious.  Nonetheless, this is a great movement and tool to use.  Some even suggest drawing the muscles, tendons, nerve fibres, etc on your body (wash off before entering exam hall of course) to fully understand where these parts are present and their size. 

It's in the name! A lot of muscles, tendons, ligaments, etc. are named in such a way that it informs the reader of their role and location.  For example: flexor hallucis longus muscle.  

Flexor = flexes the joint it crosses- muscles only act on the joint that they cross!
Hallucis = big toe, therefore this muscle acts on the big toe
Longus = it is a 'long' muscle which suggests it would insert in the distal (distant) phalanx of the big toe.  

This is a great way to eliminate potential answers, for example in multiple choice questions where you aren't sure if a muscle would aid in a specific movement. Similarly, if you are asked to look at pro-sections, this enables you to determine the accurate muscle movements involved if asked 'which muscle aids in flexion of the big toe?'.   Thus, be sure to take a few deep breaths and look at the information logically if you are unsure.

Clinical conditions.  In my experience, learning the clinical conditions really facilitated my memorisation.  When you study what went wrong in a clinical condition, you can solidify the role of that particular body part.  For example, if the the big toe cannot be flexed, because there is something wrong with flexor hallucis longus muscle, its action on the joint makes more sense. Although it may feel irrelevant when learning about pure anatomy and physiology, it actually highlights the importance, position, and movement of particular body parts.  

Drawing. Unleash your inner artist! Drawing furthers your memorisation as it requires you to actively recall the length and location of the muscles, bones, tendons, ligaments, nerves, and arteries.  I would draw on my white board instead of a paper personally but I feel using colour on paper will make the information stick faster and better. Sometimes, its more efficient to review your own drawings than pictures from textbooks. 

Mnemonics. These are your best friend.  The number of mnemonics that have helped me study anatomy is unreal.  In the bones of the hand:  

Start - Scaphoid
Left - Lunate
To - Triquetral 
Pinky - Pisiform
Here - Hamate
Comes - Capitate
The - Trapezoid
Thumb - Trapezium

I have heard positive reviews about Mnemonics for medical students and study tips by Khalid Khan and recommend purchasing this.  My professors even suggested this book and you can purchase it here. 

Those are my main tips!  Anatomy involves finding the most suitable revision technique for you prior to memorising the information.  Afterwards, it is a very steep curve of success.  Do not be discouraged and enjoy the journey.  My tips and resources are simply potential tools that anyone can utilise but if you find they do not work for you, feel free to ask your personal tutor, friends, lecturers, or google other blogs that discuss ideas on how to efficiently study anatomy.  The beauty of anatomy - it never changes!

Thank you for reading.  

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Review | Sareeka UK

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After my wonderful experience with Andaaz fashion, I couldn't help but try out another online store to review.  Sareeka is another online south-Asian ethnic wear store that has an array of dresses and suits available.  The range of options is quite overwhelming! 

On the 8th of May I graduated from Imperial College London at Royal Albert Hall.  In my experience, I feel the most confident when wearing ethnic wear in comparison to western formal/occasion dresses.  It seems that lehengas and anarkalis give off the regal and princess vibe that I love. Thus, I went onto Sareeka to order a stunning and over-the-top anarkali.  One of my best friends gifted this gorgeous number for me as a graduation and birthday present!



Delivery Time: 

The one major downfall of Sareeka is their delivery.  I have ordered another dress from this website but found, to my dismay, that they consistently ship later than promised.  This is a huge negative in comparison to Andaaz fashion, if you require something urgently.  I was told the dress would ship on the 27th of April, but instead it shipped 1st of May making it tight on arrival.  Luckily, the dress arrived the day before my graduation on the 7th of May, despite the fact that it should've arrived within 2 days of shipping in accordance to their website. 

A second dress (I will review/discuss when it arrives) was due to ship by the 22nd of May but is still 'processing' (it is the 27th of May as I write this).  Therefore, if you require something urgently and quickly then I suggest you do not order from Sareeka. Otherwise, make a purchase at least 3-4 weeks in advance. 

The Dress:


Sorry for the picture quality!  I will take better pictures in the dress in the future to provide a better idea of its appearance. The dress certainly has the gorgeous embroidery that you see in the picture above the last.   It is a soft baby-pink colour which offers elegance with a youthful vibe.  My favourite feature is, in fact the dupetta as it the work done on the scalloped edging is phenomenal.  It emphasises on the regal illusion we are trying to portray.   This is complemented by the scalloped edging on the frock.  The pattern is also present down the sleeves which, as mentioned in previous posts, shows effort and attention to detail by the designer.  I love this feature as it caters to the idea of unison and ties in all of the characteristics of the anarkali. 

The stunning details of the dress dismissed the need for intense jewellery so I wore simple stone-stud earrings. Furthermore, the dress is exceptional quality due to its heavy weight despite a couple loose-ends/threads at the hem.  Due to the embellishments, it requires proper packaging and care but certainly will last a life time.

The picture on the website demonstrates more structured pleats than that on the actual dress.  Therefore, if you wish to achieve that affect, wearing a thick petticoat may be necessary for that shape. 

The Tailoring: 

Usually, a tailor will request your raw measurements and provide an inch or two for slack to allow you to slip in and out of your dress.  This is useful as one tends to vary in weight or size throughout the year (and sometimes day! i.e after a large meal).  I felt that Sareeka provided a bit too much slack as the dress fit loosely and lacked shape on my figure. Luckily, wearing the graduation gown hid this fact. Thus, paying extra for tailoring can seem disappointing.  In addition, had I not paid for tailoring, I would've received the dress earlier and gotten it tailored in person at a dresser.  Lastly, I selected the option for a zipper at the back to get in and out of the dress but this was not provided. Hence, I do not believe Sareeka tailors dresses well. One should buy their products and ask them to tailor them to your raw measurements instead of giving them the permission to 'give way'.  

The Price: 

I truly believe that Sareeka pricing is on the 'cheaper' end of the spectrum in terms of asian wear.  Shopping at brick-and-morters can be much more expensive and generally, dresses of a similar price will be of lesser quality and unstitched.  The dress came with a beautiful chunni/dupetta and a pair of trousers. The dress did look as it did in the pictures online despite the lack of pleating which could simply be due to the way in which it was packaged and can be fixed with proper folding, care, and/or a petticoat to hold its shape.

In essence, bar the tailoring and delivery, I do believe Sareeka is a good website to order from and most certainly I will (and have) order again in the future.  Just ensure that you get professional measurements either done by a local tailor or tick 'raw measurements' when ordering, and order well in advance to the occasion or function you wish to wear the product to. 

Thank you for reading! 

 
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What's inside 'Fair and Lovely'?

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It is to my absolute pleasure that I have successfully completed my exams this month and, as promised, can post much more regularly!  I thought it would be exciting to do a product ingredients breakdown and analysis of the popular South Asian fairness cream 'Fair and Lovely'.  The version I will be discussing is, what I believe to be their most common one: Advanced Multivitamin Daily Fairness Expert Facial Cream. 

Here is a table of all the ingredients labeled on the box: 






DISCLAIMER: Take my findings/literature review with a pinch of salt.  They may not accurately represent the 'Fair and Lovely' product itself. Be sure to always do a patch test before incorporating any new products into your regime.  Do not hesitate to discuss and seek advice from a GP or dermatologist for further information about any skin care products you are concerned about.  I am not a doctor nor cosmetic chemist.  I am just a medical student, who has completed an undergraduate degree in Molecular Medicine.  Do not use this post as a replacement of a medical professionals'  advice. 





Before carrying on, I want to say that everyone should be comfortable, happy, and feel beautiful in their own skin.  Personally, I do not want to promote this product and am not encouraging individuals to purchase it.  I am simply doing this post to highlight what the product is made up of and to determine whether it effectively 'whitens' the skin.  


This is going to be a very long post but I didn't want to skimp out on information.  Any potential negatives that I found will be in red (with justifications) for ease of reading. 

Let's begin!


Palmitic Acid:

Palmitic acid (C16H32O2) is type of saturated fatty acid that can is also referred to as 'hexadecanoid acid'.  (1) (2) It is found in many edibles such as dairy products, fruit of the 'oil palm' or Elaeis genus, soybean oil, cocoa butter, and sunflower oil. (3) Excess carbohydrates and proteins in the body are naturally broken down and converted into palmitic acid via de novo fatty acid synthesis.  It is the first fatty acid produced during the production of lipids (lipogenesis).  Lipids are oils, fats, or wax that cannot be dissolved in water.  Thus, palmitic acid is present in the diet and also synthesised by the body endogenously. It plays a vital role in maintaining cell membrane integrity, the secretory and transport of lipids, and signal transduction is important for carrying out many bodily processes. In the lab, palmitic acid has been found to be an irritant despite its extensive use in soaps and cosmetics.  Furthermore, some individuals have reported mild skin irritation upon use of products containing palmitic acid so it is unclear if it is the palmitic acid itself, or other ingredients that are present in the product.  (4) In cosmetics, palmitic acid is usually in the form of sodium palmitate.  A study found that, as we age, our composition of palmitic acid can decrease from 7% - 56%.  The same study researched fatty acid composition of the forearm epidermis, which is most likely to be exposed to processes involved in photoaging (for example, UV radiation), in comparison to the buttocks which will be covered in most circumstances. Composition decreased by about 11% in the forearm compared to the buttocks of the same individuals with significant p values. (5)  Lastly, some sources claim that palmitic acid can be drying and is allowed to be used up to 13% in products as recommended by the Cosmetic Ingredient Review Expert Panel. (8)  Therefore, this highlights how crucial it is to carry out a patch test alongside having dosages available to the consumer on the side of cosmetic packets. (6)  Palmitic acid is added into cosmetic products due to its function as a surfactant which acts to mix non-water soluble products such as fats, oils, and wax with water.  Hence, it is commonly used in face washes to get rid of dirt, grime, or grease.  Nonetheless, it also plays a role as an emollient which aims to soften and sooth the skin.  It aims to create a barrier on the skin to prevent loss of moisture (rather than directly providing it).  (7) Finally, a study Zhou et al 2013 demonstrated that palmitic acid could contribute to acne inflammation and pilosebaceous duct hyperkeritinisation through secretions of IL-6, TNF-alpha, and IL-1Beta.  These are IL-6 and IL-1Beta are interleukins and TNF-alpha is a cytokine that is involved in cell signalling protein; resulting in systemic inflammation.  This explains the acne inflammation.  (9)

Stearic acid: 

Stearic acid (C18H36O2) is a long-chain fatty acid which, similar to palmitic acid, can be found naturally in plant and animal fats, cocoa butter, and shea butter.  The physical properties of stearic acid classify it as an emollient.  It acts to reduce water loss through the formation of a protective barrier. On top of this, it also acts as a surfactant; giving it cleansing properties. (12) Lab tests say that stearic acid is an irritant, like palmitic acid, however, minimal skin irritation has been reported in individuals using stearic acid. (10) Repeat skin tests did not demonstrate an allergic reaction but we are not aware of the study confounders, how many individuals were involved in the study, and other potential allergens in the products used for testing that could cause mild irritation. Stearic acid makes up about 10% of the stratum corneum which is plays an important role in maintaining skin permeability and integrity.  (11) The CIR found that there were little to no apparent toxicity in the use of stearic acid topically.  There is little to no eye irritation and are discovered to be non-carcinogenic as long as maintained within the range of 0-13%.  Beyond this, little research is available so there are gaps in the evidence base. Mukherjee et al in 2010 found that stearic acid was delivered to the stratum corneum after five washes with a soybean oil formulation.  Therefore, the stearic acid was incorporated into this layer of the skin 'most likely in the corneum lipid phase' so it contributed to the structure and function of this vital skin barrier. (13) However, in contradiction, Dr. Leslie Baumann, MD, states that “while stearic acid is an important component in stratum corneum lipids and a widely used ingredient in skin care products, there is a dearth of data on its significance, if any, in the topical dermatologic armamentarium beyond its primary activity as a surfactant and emulsifying agent. Specifically, it remains to be seen whether stearic acid can be replenished in the stratum corneum through topical treatment. Much more research is needed in this area to assess the potential of stearic acid as a therapeutic agent.” 

Niacinamide:

Niacinamide is a form of vitamin B3 that has been used in creams for treating acne. Hence, explaining the 'advance vitamin' advertisement on the cream. (14)  Natural sources of niacinamide include greens, meat, eggs, milk, and cereals.  It has been known to aid individuals with inflammatory skin conditions as a result of its anti-inflammatory properties.  Niacinamide increases ceramide production of human keratinocytes which is found in high concentrations in the cell membrane.  This improves epidermal permeability in vivo. (15) Research shows that it slows down the production of IL-8 which is an interleukin involved in inflammatory processes and secretion of sebum. (16) (15) A study showed that niacinamide can also play a crucial role in decreasing the risk of skin cancers, bar melanoma, in those at high risk but further research is required to affirm this claim. (17) Aesthetically, niacinamide is meant to increase the softness and appearance of skin; especially via restoring suppleness and reducing flaky/dryness.  (18)  Farris et al found that niacinamide alongside retinol 0.5% in topical creams does play a role in skin brightening and anti-aging but should be used in conjunction with SPF 30.  Fine lines, radiance, and smoothness improved by week 2 with a p value of less than 0.001 and after week 4, hyperpigmentation, and skin clarity also significantly improved. After 10 weeks, participants did not show signs of irritability, dryness, stinging or tingling. (19) Niacinamide alongisde retinol is said to be well tolerated and show significant improvements when used topically.  This paper suggests that it does not compromise barrier function. (20) Further studies are starred below which demonstrate the benefits of niacinamide for your reading and research pleasure.  I was unable to find any negative side effects or the affects of high dosage topically. 

Glycerin:

Glycerin has been proven useful as its molecular structure allows for easy penetration into the skin.  It acts as a humectant which is a product that retains moisture; justifying its use in facial creams.  It has been suggested that it attracts moisture to the top visible layer of the skin (epidermis) by drawing in aquaporins (water channels and integral membrane proteins) that increase the flow of water to the epidermis. I couldn't find studies which correlate topical use of glycerin with aquaporins so I am not sure how credible this information is.  Overall, it is said to pull in moisture to the skin surface though the mechanism is not confirmed. This aids in hydration, tackling dullness, and facilitating that youthful glow.  The Cosmetic Ingredient Review (CIR) did an in dept analysis of the use of glycerin in skincare. (3)  In terms of acute toxicity, it was found that, if ingested, participants in the study suffered from headaches, vomiting, nausea, thirst, and diarrhoeaDo not eat any makeup/skincare products. Glycerin is used in over 75% of moisturising leave-on products, however, some individuals in a study found it to be irritating on the skin so patch tests are vital


Cetearyl ethylhexanoate: 


What a mouthful!  There are data gaps with regards to this product.  It is found to predominantly be involved in skin conditioning. The CIR found that there is 'method deficiencies and data gaps'.  However, it was found to cause dermal irritation when undiluted but more data is required to see the full benefits and risks. (21)  It acts as an emollient to sooth and lubricate the skin.  Cetearyl ethylhexanoate ensures the product is easier to spread and feel silky to touch.  (22)

Isopropyl myristate:

Isopropyl myristate (C17H34O2) is formed through esterification (reacting) of ispropyl alcohol and myristic acid.  It is used in skin care products to increase absorption of the product into the skin.  One research paper by Bruno in 2006 stated that isopropyl myristate is a weak sensitiser, testing positive in those individuals with perioral dermatitis (skin rashes around the mouth).  It increased water loss through the skin.   It was advised that individuals with perioral dermatitis avoid products containing isopropyl myristate. (23) On the other hand, isopropyl myristate is meant to increase absorption of water into the skin; aiding moisture loss by increasing hydration.  As mentioned earlier, it furthers the absorption of other ingredients in the product.  Lastly, it is mainly used as a thickener to give creams a more luxurious texture.  (24) It was further suggested that those with thinner skin or applying it on thinner areas of the face (especially around the eyes and lips) are at a higher risk of experiencing irritation due to its ability to penetrate the skin.  If a product has carcinogens, the absorption of those carcinogens will be greatly enhanced.  In addition, isopropyl myristate, in some studies, resulted in clogged pores which caused breakouts due to the inability of sebum to leave the skin.  However, an argument against this is that modern data does not discuss how isopropyl myristate is used in products today.  Thus, its function may be different so more research is required to fill these data gaps. (25)  It comes to no surprise that isopropyl myristate should be used in regulated quantities given that a study in 2004 discovered that two universities in UK hospitals had patients with allergic contact dermititis after exposure to isopropyl myristate.  (26) CIR claim strong evidence is present to classify ispropyl myristate as an irritant, especially when used around the eyes, skin, and even lungs if in an aerosol form. Nonetheless, more evidence is required. (27) This is affirmed by PubChem which class this as an irritant during lab testing. (28)


Ethylhexyl methoxycinnamate:


This is also known as octyl methoxycinnamate (C18H26O3).  It commonly used in sunscreens as an agent which absorbs UV-B radiation.  Therefore, it protects individuals from UV-B radiation.  Studies found that it does not penetrate the outer layer of skin in high enough concentrations, when in the product, to have a toxic impact on human keratinocytes or human skin cells. (29) However, a different study conducted in 2017 by Sharma et al suggested that ethylhexyl methoxycinnamate could damage human DNA cells; demonstrating significant toxicity to the genome which can give rise to damaged and mutated DNA. (30) Upon UV radiation exposure and octyl methoxycinnamate, gene expression studies found 'differential changes' to some of the genes studied in two human cell lines.  This included changes in p53 protein expression. p53 is an important cell-cycle regulator and tumor suppression protein. In this study only 17 genes were used in the panel to asses genotoxicity so it is very possible that other genes were also affected. (31) The FDA has permitted its use up to a concentration of 7.5% which emphasises the importance of dosage labelling on the packet.  Finally, in 2017, Necasova et al carried out an experiment which found that ethylhexyl methoxycinnamate (EHMC) is present in two dimers: trans-EHMC and cis-EHMC.  This is two different structures or 'isomers' that EHMC can take.  The risk of genotoxicity with cis-EHMC is 1.7 times greater compared to trans-EHMC which further exacerbates the need of dose labelling. The study reiterates the necessity in further toxicology experiments regarding the safety and efficacy of EHMC.  (32) (33) Butyl methoxydibenozoylmethane destabilises EHMC so its use in combination with stabilisers is vital. (34) Finally, data shows that EHMC can demonstrate endocrine dysfunction (affect endocrine function in the body) however more research and contribution to the evidence base is required to explain the long-term health risks. (35) Nonetheless, the dosage that we consume is most likely safe and has little to no genotoxicity.


Butyl methoxydibenzoylmethane:


Butyl methoxydibenzoylmethane is used as an UV-radiation A filter to absorb and prevent damage due to UV A radiation.  (36) It also goes by the name avobenzone and its use is permitted by the FDA and Cosmetics directive of the European Union by 3% and 5% respectively.  There isn't much available data discussing the risks of butyl methoxydibenzoylmethane. 


Hydroxystearic acid:

This is a stearic acid with a hydroxyl group though where it is present on the chain of fatty acids is unknown due to the nomenclature on the ingredient box.  Thus, this is a hydroxy fatty acid. (37) The role of hydroxystearic acid appears to be  reducing hyperpigmentation and discoloration of the skin.  A study by Mi et al in 2018 found that 12-hydroxystearic acid actually aided in reducing discoloration when exposed to benzo(a)pyrene through anti-inflammatory and anti-oxidant pathways. (38) Shutz et al in 2019 reinforce the findings of the Mi et al study as they found that hydroxystearic acid improved the appearance of sun spots. (39) Finally, Hawkins et al in 2013 found that hydroxystearic acid had skin lightening properties, explaining its use in Fair and Lovely.  It improved the appearance of photodamaged arms.  However, although this may be the case and there are studies supporting the benefits of hydroxystearic acid, the study by Hawkins et al 2013 was carried out by many PhD students that were a part of Unilever's Research and Development department. (40) The CIR claim hydroxystearic acid is safe to use in cosmetics.  (41) More information on the full review of hydroxstearic acid is available at reference 41.  


Sodium ascorbyl phosphate:



Sodium ascorbyl phosphate is a water-soluble form of Vitamin C and acts as an antioxidant by donating electrons to free-radicals to prevent free radical damage. (44) It acts as a free radical scavenger and replenishes Vitamin E sources. Vitamin E is an antioxidant which protects against lipid peroxidation. Lipid peroxidation is a process by which the cell's membrane loses integrity; causing leakage and damage to the cell. It also works to brighten and even out skin tones.  (42)  Sodium ascorbyl phosphate has a strong antimicrobial affect at 1% concentration; promoting its use in acne creams and treatments. (43)

Tocopheryl acetate:


Tocopheryl acetate (C31H52O3) is also known as vitamin E acetate. It is formed through an esterification reaction involving acetic acid and tocopherol.  It is claimed that tocopheryl acetate can penetrate the skin and enter cells; where 5% of the tocopheryl acetate will be converted to tocopherol.  This is 'free' tocopheryl.  It is able to provide protection against ultraviolet radiation. (45) To add, tocopheryl acetate has been found to improve the appearance of scars and wound healing but more evidence and studies are required to reaffirm these claims. (46) Vitamin E is very common in skin care products but tocopheryl acetate was found to cause allergic contact dermatitis.  This is an allergic response that is induced via contact/touch with a particular substance, product, or ingredient. (47) Therefore, with any skin care product, a patch test is necessary. Overall, however, the benefits of vitamin E (antioxidant and photoprotective properties) makes it a staple in many skin care products.  On the other hand, CIR claim that it is a human skin allergen.  One explanation is its contamination with hydroquinone which is used topically for skin whitening and depigmentation. (48) The FDA said that hydroxyquinone cannot be ruled out as a potential carcinogen.  It acts to decrease the number of melanocytes (melanin pigment cells) present in the individual via inhibition of the enzyme that catalyses the reaction of tyrosine to dihydroxyphenylalanine.  It has been associated with dryness, pruritus (itchiness), erythema (redness), irritation via contact dermatitis, and ochronosis which is blue/black discoloration of the skin. (49) Finally, it has been categorised as an irritant, corrosive, health hazard, and environmental hazard by PubChem. (50) Although there is no confirmation whether or not hydroquinone is present in fairness creams, or Fair and Lovely specifically, this is important to consider.  It is similar to the association of talcum powder with asbestos.  We cannot assume that all products with tocopheryl acetate also include hydroquinone. Other sources about tocopheryl acetate are listed below in the bibliography section.


Allantoin:


Allantoin (C4H6N4O3) is naturally synthesised in many bacteria and animals from uric acid but in humans and can be obtained naturally from diet. (51) In cosmetics, it is extracted from compfreys or chamomile and can be used in, up to 2% concentration.  It is known to be effective at skin smoothing and conditioning.  (52) Allantoin promotes wound healing via stimulating fibroblastic proliferation - a cell that is present in connective tissue of the body which produces collagen and the extracellular matrix; providing the stroma or structural framework of the tissues.  (53) This is supported by further research which found that allantoin helps heal wounds and skin irritations via the stimulation of healthy tissue growth.  Thus, explaining its use in anti-acne products and cleansing/clarifying lotions, creams, or face washes. (54) Savic et al in 2015 conducted a study that reiterated the beneficial use of comfrey extract in the treatment of skin irritations. (55) On the other hand, allantoin is also classified as a keratinolytic meaning it has the ability to remove excess skin (lesions, warts, calluses) and thus prevent dryness and itchiness but there aren't enough studies available to support this claim. (56)


Pyridoxine hydrochloride:


Pyridoxine hydrochloride is a hydrochloric salt form of water-soluble vitamin B6.  Vitamin B6 is plays a role in antioxidation and Pyridoxine hydrochloride will be converted to pyridoxal-5-phosphate which acts as an enzymatic cofactor in many metabolic processes: amino acid synthesis, neurotransmitters and sphingolipids. Hence, it is crucial in immune system, skin, gastrointestinal, and nervous system regulation. However, there has been some cases of this causing skin irritation in individuals.  (57) Muruta et al carried out a study that found that two patients had photosensitive allergic reactions to pyridoxine hydrochloride but the pyridoxine hydrochloride was given intravenously rather than topically.  Furthermore, a sample size of two is not sufficient to determine the risks and benefits of topical pyridoxine hydrochloride.  (58) Toxicity depends on dosage, application versus IV etc. with risks ranging from asymptomatic to cancer. (59) 


Cetyl alcohol:


Cetyl alcohol (C16H34O) works popularly as an emollient, thickener, and surfactant. It is a fatty alcohol. (60) Given its properties as an emollient, it smooths and softens the skin; reducing the appearance of flakey dryness.  It works as a thickener, which improves the spreadability and texture of the skin care product it is used in.  The CIR Expert Panel found that cetyl alcohol is safe for cosmetic use as it is considered non-toxic and non-sensitising.  However, it has been found that cetyl alcohol can prove irritating to those with sensitive skin or sensitive skin conditions such as eczema, psoriasis, and rosacea.  Again, patch tests cannot be avoided.  (61) This is supported by further studies that claim cetyl alcohol has mild skin and eye irritant. Nonetheless, there aren't any recorded cases of major irritation of the skin and eyes. (62) Unlike alcohol, fatty alcohols are generally safer and non-irritating. 


Dimethicone: 


Dimethicone (C2H6OSi)n is a form of silicone which is a popular buzzword in skincare and beauty. Dimethicone is another ingredient which works to give the cream a silky and matte finish on the skin.  Thus, it is used for the texture of the product rather than benefiting the skin itself. Commonly, dimethicone is found in makeup primers due to its ability to fill in pores and fine lines on the face.  Dimethicone is a large molecule so it acts as a physical barrier to prevent water loss or even some pathogens from causing infection. However, some individuals find that products with dimethicone clog pores and induce/exacerbate acne.  This is only unrecorded/word-by-mouth cases rather than case studies.  (63) The CIR say that dimethicone is permitted in the use of cosmetics up to 15% concentration. Surprisingly, despite dimethicone or silicones being popular in the skincare world, there is a scarce amount of data discussing the pros and cons of using this ingredient. Nonetheless, oily skin generally does not fare well with the use of dimethicone but on the other hand, a study discussed dimethicone in a positive light as it is commonly used in acne products due to its anti-inflammatory, hypoallergenic, and noncomedogenic properties. (64) Noncomedogenic properties means that the skin care product does not clog pores.  Therefore, there are evidence gaps discussing this product and more information and studies need to be carried out to discuss its benefits and negatives. Some physicians say that dimethicone does accumulate in the body over time but results are inconclusive. 


Titanium dioxide:


Titanium dioxide (TiO2) is commonly used as a pigment, sunscreen, and a thickener.  This is due to its strong UV A and B radiation absorbing abilities. (65) Sadrieh et al in 2010 conducting a study whose findings demonstrated that nanoparticle titanium dioxide did not penetrate the intact epidermis of the skin. Therefore, it is less likely to cause severe side effects. (66) On the other hand, two other studies found that, in the long term, nanoparticles of titanium dioxide could have potential toxic effects though more research needs to be conducted. (67) Similarly, it was found that titanium dioxide there is a need to reduce the production of reactive oxygen species (ROS) with the use of titanium dioxide. (68) This leads to free-radical production which can react with proteins, DNA, lipids, and carbohydrates in the body. 


Aluminum hydroxide:


Aluminum hydroxide (Al(OH)3) is mainly used as a colorant or to improve spreadability of titanium dioxide in products.  It is also commonly used in antiperspirants. Alumnium penetration into the skin is said to be 'shallow' or not deeply penetrative from topical exposure. (69) Thus, it is usually not associated with dermal irritation or inflammation. The CIR has labelled aluminum hydroxide as safe to use in cosmetics at specific doses and concentrations. (70) In creams, it is said to protect against skin allergens such as nickel or neomycin, exhibit protection of skin against removal by water, and minimal irritative potential, for the management of ezcematous dermatitis. (71) There has been slight irritation in skin and the eyes cases of patients. (72)


Phenoxyethanol:


Phenoxyethanol is a common antibacterial ingredient in skin care and perfumes.  It is permitted in cosmetics and fragrances in concentrations up to 1%. (73) The FDA state that phenoxyethanol can result in contact dermatitis which highlights the importance of patch tests.  However, at the concentrations used in cosmetics (0.5-1%), the drastic impacts on the central nervous system for example are not seen in comparison to 100% phenoxyethanol.  Nonetheless, if used regularly/everyday, some physcians state that this can accumulate but more information and studies assessing long-term phenoxyethanol use at cosmetic concentrations is vital.  The CIR and European Commission on Health and Food safety hence state that its use is safe at 1% or lower. Finally, phenoxyethanol has been found to result in skin sensitisation, irritancy, and local/systemic toxicity via dermal exposure. (74)


Methylparaben:


Methylparaben (CH3(C6H4(OH)COO) is a preservative in many products. This is due to their bactericidal and fungicidal properties. It is readily absorbed through the skin. (75)  Ishiwatari et al in 2007 found that methlyparaben persistence and accumulation in the stratum corneum with one month of daily topical application might affect ageing and differentiation of keratinocytes (epidermal cells which produce keratin and are part of the skin) by decreasing their proliferative ability. Furthermore, there was a change in cell morphology.  (76) Another study conducted by Handa et al in 2006 found that methylparaben treated HaCat cells, reacted with UV B radiation exposure in the following way:  increased cell death, oxidative stress, NO production, lipid peroxidation (as a result of free radical formation), and activation of transcription factors.  However, practical concentrations of methylparaben (0.003% at the time of the study) had little to no effect to UV B radiation. Therefore, as per usual, it is important to consider the differences in dose and concentration in cosmetics and experimental settings.  (77) This furthers the innate need for dosage or concentration labels on cosmetics.  Finally, the previous study did suggest that methylparaben can accumulate in the dermis of the skin.  Thus, long-term studies assessing the use of methylparaben and its consequences is vital. A later study in 2017 evaluated the impact of methylparaben on human dermal fibroblasts cells and the production of collagen.  Cells were treated with concentrations of 0.01%, 0.03%, and 0.05%. As concentration increased, Type 1 collagen synthesis decreased. Type 1 collagen is the most common form of collagen in our body.  There was also an increase in expression of caspase-3 which is protein involved in apoptosis which is programmed cell death.  Thus, methylparaben was found to potentially increase apoptosis of cells. (78)  This is supported by Dubey et al in 2017.  Photosensitive methylparaben leads to oxidative stress, thus DNA damage and apoptosis occurs through the mitochondria and ER.  (81) Parabens have resulted in contact dermatitis in some individuals upon exposure though the mechanism of sensitivity is unknown.  The risk of an allergic reaction or sensitivity reaction is usually when paraben-containing compounds are applied to broken or damaged skin. (79)  Pazourekova et al in 2013 determined that parabens are a preferred preservative in 'rinse-off' products such as face washes rather than leave on cosmetics such as lotions and creams. (80) Methylparaben is permitted in concentrations up to 0.4%. 


Propylparaben: 


Propylparaben (C10H12O3) is another preservative commonly used in cosmetics. Similar to methylparaben, cases of eye and skin irritation due to exposure to propylparaben have been reported though allergic reactions to parabens is generally rare in humans. (82) It is found naturally in plants and insects.  In 2010, the European Union Scientific Committee deemed propylparaben safe to use in cosmetics at concentrations less than 0.19% (83) The Human Toxome Project found that propylparaben was present in the urine of 26/28 study participants. Therefore, this demonstrated that propylparaben has the ability to systemically travel in the body upon application. (84) Similar to methylparaben, it is said to be sensitising on damaged or broken skin but was not found to be carcinogenic (cancer-causing), mutagenic (mutating DNA), or clastogenic (disrupt chromosome structure/function). (85) In addition, propylparaben exhibited weak competitive binding on androgen receptors. (87) However, Kirchoff et al in 2013 believe that data is currently inconclusive so more research needs to be conducted to understand the full affects of parabens in skincare. (88)


Potassium hydroxide:


Potassium hydroxide (KOH) is generally used as a buffer to maintain the pH of the product.  This ensures that the pH of the skin (acid mantel) does not dramatically change whilst using the product. It is used as both a food additive and in cosmetics. (89) Topical potassium hydroxide at concentrations around 5% have been used for treating warts; usually a result of the human papilloma virus (HPV).  In this context, potassium hydroxide was 'safe and effective'. (90) Given that we do not know the concentration at which potassium hydroxide is used in the cream, it is hard to discuss the impact this ingredient has on the individual.  This is because severe reactions to potassium hydroxide occurs at high concentrations due to the penetrative properties of alkali chemicals on the skin. Cases have shown that potassium hydroxide is highly corrosive and irritating on the skin and eyes at high concentrations and regular dosages. (91) At lower concentrations, there are cases of mild skin irritation. (92)  However, given the product, I do believe the main role of potassium hydroxide is a buffer rather than treatment of the skin. Therefore, I would not be too concerned at its inclusion in this cream. 

Disodium EDTA:

Disodium EDTA is used to ensure that the cream is at an ideal viscosity.  The CIR state that disodium EDTA can increase skin absorption which suggests it would also increase penetration of the product via the action of 'chelation'.  This can be a cause for concern if the ingredients used alongside disodium EDTA are harmful when absorbed. (93) EDTA will produce systemic exposure levels, which lay beneath what is classified as 'toxic' when conducting oral dosage studies. It is not carcinogenic, but it is genotoxic and cytotoxic.  At the levels used in cosmetics (2%), this generally does not cause any toxic side effects. (94) 

Isopropyl titanium triisostearate:

Isopropyl titanium triisostearate is a fatty acid  whose sole purpose is an emollient and pigment. (96) Furthermore, it was not found by the CIR to have any sensitising affect or cause skin irritation. (95)

Triethoxysilylethyl polydimethylsiloxylethyl dimethicone: 


Wow. Unsurprisingly, there are quite a few data gaps on this silicone which aims to soften the skin.  Unfortunately, given that data is very sparse and more evidence is required to assess the risks and benefits of triethoxysilylethyl polydimethylsiloxylethyl dimethicone, it is hard to have an educated opinion on this ingredient.  Nonetheless, the CIR found that no adverse affects, with use of this ingredient, took place in the various studies conducted on different accounts with its use in topical creams. (97) 

CI 15510:


Also known as acid orange 7, CI 11510 is a cosmetic colorant. (98) This is allowed in all cosmetics bar those that are intended to be used around the eye such as makeup remover.  Therefore, be vary with use of this cream near the eyes as a recurring theme appears to be thin skin is more susceptible to irritation or sensitisation. (99)  It is also found to have some irritation on the skin but it is not clear what doses can result in or show the first signs of irritation.  Thus, more information is required on the doses in this particular product.  (100)

CI 17200: 


CI 17200 is also referred to as 'red lake 33' or 'acid red'.  (101) Studies showed that CI 17200 is not a skin sensitiser, therefore, does not result in an allergic or hypersensitivity reaction. (102) However, this experiment took place amongst guinea pigs rather than human beings and the sample size was only 15. This may not be representative of the human population or population that uses this cream.  

CI77491:

Finally, this is usually representative of iron oxides. Despite the existing data gaps, there have been suggestions that this can result in bioaccumulation in wildlife and humans.  Therefore, one should take precaution. They are produced synthetically to prevent ferrous or ferric oxides which have differing reactivities to CI 77491. 

In essence, we have managed to break down 'Fair and Lovely' in as much detail as possible from using existing studies or sources which used published papers in accredited journals! This took a lot of time and effort, but I am very proud of this piece of research.  In my opinion, I would not use Fair and Lovely as there are better creams available for cheaper that will demonstrate higher levels of hydration and water retention in the skin.  I also believe the brand should list which ingredients are active and which are inactive. Data is clearly sparse for many of the ingredients we discussed which highlights the innate need for further research in cosmetics and their chemical makeup; especially with regards to long-term affects. This explains why the final few ingredients are very sparse and short in comparison to the rest of this post. Furthermore, if you are using this cream with intention to get fair, as much as that is your individual choice, there aren't many active ingredients involved which act to lighten and brighten the skin.  Thus, it emphasises on how this appears to be a gimmick.  Obviously, given that we are not informed of concentrations or doses, it is hard to make a firm decision on the effectiveness of the product.  In addition, I do believe this product should have an independent third party study conducted with participants representing the most common target population - south asian women. Shamelessly, from personal experience (when I was younger and did not have the courage to appreciate my skin), I do not think this cream works in making the skin fairer.  I would not  use it in my future nor recommend it to others.  Underneath the references heading I have added further reading and papers that I had read but did not quote in this post. The papers reiterate the points made about the corresponding ingredient but also offer more insight to their toxicity, appropriate dosage, studies, regulations, etc. 

Thank you for reading! 


REFERENCES:

1. Gunstone, F. D., John L. Harwood, and Albert J. Dijkstra. The Lipid Handbook, 3rd ed. Boca Raton: CRC Press, 2007. ISBN 0849396883 | ISBN 978-0849396885

2. The most common fatty acid is the monounsaturated oleic acid. 
3. Purwanto, Y.; Munawaroh, Esti (2010). [Ethnobotany Types of Pandanaceae as Foodstuffs in Indonesia] . Retrieved 25 October 2018.
4. https://pubchem.ncbi.nlm.nih.gov/compound/palmitic_acid#section=Pharmacology-and-Biochemistry
5. Kim EJ, Kim MK, Jin XJ, Oh JH, Kim JE, Chung JH. Skin aging and photoaging alter fatty acids composition, including 11,14,17-eicosatrienoic acid, in the epidermis of human skin. J Korean Med Sci. 2010;25(6):980–983. doi:10.3346/jkms.2010.25.6.980
6. https://www.truthinaging.com/ingredients/palmitic-acid
7. https://thedermreview.com/palmitic-acid/
8. “Palmitic Acid”, J Clin Invest. 1993 Aug;92(2):791-8, Cosmetic Ingredient Review, “Final Report on the Safety Assessment of Oleic Acid, Lauric Acid, Palmitic Acid, Myristic Acid, and Stearic Acid”.
9. Palmitic Acid Induces Production of Proinflammatory Cytokines Interleukin-6, Interleukin-1, and Tumor Necrosis Factor- via a NF-B-Dependent Mechanism in HaCaT Keratinocytes, Bing-rong Zhou, Jia-an Zhang, Qian Zhang, Felicia Permatasari, Yang Xu, Di Wu, Zhi-qiang Yin, and Dan Luo Mediators of Inflammation Research Article (11 pages), Article ID 530429, Volume 2013 (2013) Published 29 August 2013
10. https://pubchem.ncbi.nlm.nih.gov/compound/Stearic-acid
11. Lin TK, Zhong L, Santiago JL. Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils. Int J Mol Sci. 2017;19(1):70. Published 2017 Dec 27. doi:10.3390/ijms19010070
12. International Journal of Cosmetic Science, August 2013, pages 337-345
International Journal of Toxicology, Volume 24, 2005, Supplement 3, pages 65-74
International Journal of Pharmaceutics, February 2000, pages 189-195
14. British National Formulary: BNF 69 (69th ed.). British Medical Association. 2015. p. 822. ISBN 978-0-85711-156-2.
15. Draelos, Z. D.; Matsubara, A.; Smiles, K. (2006). "The effect of 2% niacinamide on facial sebum production". Journal of Cosmetic and Laser Therapy8(2): 96–101. 
16. Kim, J.; Ochoa, M. T.; Krutzik, S. R.; Takeuchi, O.; Uematsu, S.; Legaspi, A. J.; Brightbill, H. D.; Holland, D.; Cunliffe, W. J.; Akira, S.; Sieling, P. A.; Godowski, P. J.; Modlin, R. L. (2002). Journal of Immunology169 (3): 1535–1541. 
17.Snaidr, VA; Damian, DL; Halliday, GM (February 2019). "Nicotinamide for photoprotection and skin cancer chemoprevention: A review of efficacy and safety". Experimental Dermatology. 28 Suppl 1: 15–22. 
18. Chen, Andrew C.; Damian, Diona L. (2014). "Nicotinamide and the skin". Australasian Journal of Dermatology55 (3): 169–175. 
21. CIR (Cosmetic Ingredient Review). 2006. CIR Compendium, containing abstracts, discussions, and conclusions of CIR cosmetic ingredient safety assessments. Washington DC.
29 Hayden, C.G.J.; Cross, S.E.; Anderson, C.; Saunders, N.A.; Roberts, M.S. (2005). "Sunscreen Penetration of Human Skin and Related Keratinocyte Toxicity after Topical Application". Skin Pharmacology and Physiology18 (4): 170–4. 
30. Sharma, Anežka; Bányiová, Katarína; Babica, Pavel; El Yamani, Naouale; Collins, Andrew Richard; Čupr, Pavel (2017). "Different DNA damage response of cis and trans isomers of commonly used UV filter after the exposure on adult human liver stem cells and human lymphoblastoid cells". Science of the Total Environment. 593-594: 18–26. 
32. Nečasová, Anežka, et al. “New Probabilistic Risk Assessment of Ethylhexyl Methoxycinnamate: Comparing the Genotoxic Effects Oftrans- Andcis-EHMC.” Environmental Toxicology, vol. 32, no. 2, 2016, pp. 569–580., doi:10.1002/tox.22260.
33. Sharma, A., et al. “DNA Damage of Ethylhexyl Methoxycinnamate: Cis-EHMC Can Cause More Significant Effect in Comparison with Trans-EHMC.” Toxicology Letters, vol. 258, 2016, doi:10.1016/j.toxlet.2016.06.1760.
42. Drug Research, October 2016, ePublication. Journal of Photochemistry and Photobiology, August 2009, pages 130-135. International Journal of Cosmetic Science, December 2008, pages 453-458. International Journal of Cosmetic Science, June 2005, pages 171-176
45. Beijersbergen van Henegouwen G, Junginger H, de Vries H (1995). "Hydrolysis of RRR-alpha-tocopheryl acetate (vitamin E acetate) in the skin and its UV protecting activity (an in vivo study with the rat)". J Photochem Photobiol B29 (1): 45–51.  
46. Panin G, Strumia R, Ursini F (2004). "Topical alpha-tocopherol acetate in the bulk phase: eight years of experience in skin treatment". Ann. N. Y. Acad. Sci1031: 443–447
51. Young E. G.; Wentworth H. P.; Hawkins W. W. (1944). The absorption and excretion of allantoin in mammals. J. Pharmacol. Exp. Ther81 (1): 1–9.
52. Pharmacognosy Review, Volume 5, July-December 2011
International Journal of Toxicology, May 2010, Supplement, pages 84S-97S
Journal of Occupational Medicine and Toxicology, October 2008, ePublication
61. FDA, “Synthetic Fatty Alcohols”, 2017, Cosmetics Info, “Cetyl Alcohol”.
62. https://pubchem.ncbi.nlm.nih.gov/compound/1-Hexadecanol
63. https://www.vogue.co.uk/article/skincare-ingredients-what-is-dimethicone
64. Del Rosso JQ. Moisturizers: Function, formulation and clinical applications. In: Draelos Z, Dover JS, Alam M, editors. Cosmeceuticals. 2nd ed. China: Saunders Elsevier; 2009. pp. 97–102. 
65. Dan, Yongbo et al. Measurement of titanium dioxide nanoparticles in sunscreen using single particle ICP-MS. 
66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855360/
67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555280/
68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3781714/
69. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782734/
70. https://journals.sagepub.com/doi/abs/10.1177/1091581816677948?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=ijtb
71.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016934/
72. Grant, W.M. Toxicology of the Eye. 3rd ed. Springfield, IL: Charles C. Thomas Publisher, 1986., p. 73
73. Regulatory Toxicology and Pharmacology, December 2016, page 156
PLOS One, October 2016, ePublication.
Journal of the European Academy of Dermatology and Venereology, June 2015, pages 1,071-1,081. 
Cosmetics & Toiletries, 2014, issue 5, pages 24-27. 
International Journal of Cosmetic Science, April 2011, issue 2, pages 190-196
74. https://pubchem.ncbi.nlm.nih.gov/compound/2-phenoxyethanol#section=Metabolism-Metabolites
75. Soni MG, Taylor SL, Greenberg NA, Burdock GA (October 2002). "Evaluation of the health aspects of methyl paraben: a review of the published literature". Food and Chemical Toxicology40 (10): 1335–73. 
76. https://www.ncbi.nlm.nih.gov/pubmed/17186576
77. https://www.ncbi.nlm.nih.gov/pubmed/16938376
78. https://www.ncbi.nlm.nih.gov/pubmed/28382686
79. https://www.ncbi.nlm.nih.gov/pubmed/28382686
80. https://www.ncbi.nlm.nih.gov/pubmed/23872132
81. https://www.ncbi.nlm.nih.gov/pubmed/28764904
82.https://pubchem.ncbi.nlm.nih.gov/compound/Propylparaben#section=GHS-Classification
83. Directorate-General for Consumer Safety, European Union (2011).
84. https://www.truthinaging.com/ingredients/propylparaben
85.https://www.ncbi.nlm.nih.gov/pubmed/11346481
86.https://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@term+@DOCNO+203
87. https://www.ncbi.nlm.nih.gov/pubmed/19101832
88. https://www.ncbi.nlm.nih.gov/pubmed/23508773
89. https://www.ewg.org/skindeep/ingredient/705204/POTASSIUM_HYDROXIDE/
90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008052/
91. https://pubchem.ncbi.nlm.nih.gov/compound/Potassium-hydroxide#section=Household-Products
92. https://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@term+@DOCNO+1234
93. https://pubchem.ncbi.nlm.nih.gov/compound/disodium%20EDTA
94. https://www.ncbi.nlm.nih.gov/pubmed/12396676
95.https://www.cir-safety.org/sites/default/files/organo-titanium%20ingredients.pdf 
96. International Journal of Pharmaceutics, June 2014, pages 89-96
Principles and Practice of Photoprotection, edited by Steven Q. Wang, Henry W. Lim, page 297

Niacinamide:

https://pubchem.ncbi.nlm.nih.gov/compound/Ethylhexyl%20p-methoxycinnamate#section=Absorption-Distribution-and-Excretion

Tocopheryl acetate:

https://bnf.nice.org.uk/drug/alpha-tocopheryl-acetate.html
https://cosmeticsinfo.org/ingredient/tocopheryl-acetate
https://lpi.oregonstate.edu/mic/health-disease/skin-health/vitamin-E
https://www.ncbi.nlm.nih.gov/pubmed/8875555

Allantoin:

https://www.ncbi.nlm.nih.gov/pubmed/20448269

pyridoxine hydrochloride

https://www.cancer.gov/publications/dictionaries/cancer-drug/def/pyridoxine-hydrochloride

Cetyl Alcohol:

https://www.truthinaging.com/ingredients/cetyl-alcohol
https://www.ncbi.nlm.nih.gov/pubmed/27617733
https://www.ncbi.nlm.nih.gov/pubmed/29464717

Titanium dioxide:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233247/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423755/

Phenoxyethanol:

https://www.ewg.org/skindeep/ingredient/704811/PHENOXYETHANOL/
https://www.sciencedirect.com/science/article/pii/S0278691511005345?via%3Dihub#b0010
https://ec.europa.eu/health/scientific_committees/consumer_safety/docs/sccs_o_195.pdf

Methylparaben:

https://pubchem.ncbi.nlm.nih.gov/compound/Methylparaben#section=Use-and-Manufacturing
https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-use-methyl-propylparaben-excipients-human-medicinal-products-oral-use_en.pdf

Propylparaben:
https://www.ncbi.nlm.nih.gov/pubmed/11346481
https://www.ncbi.nlm.nih.gov/pubmed/24305662

Potassium hydroxide:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122278/

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