“Clean” skin care products that are free of certain chemicals are not always safer than their traditional counterparts, dermatologists warn. Arbitrary descriptions of products as “clean” or “natural” are not regulated, and many of these products contain high concentrations of ingredients that can cause irritation and allergies, the authors write in an editorial in JAMA Dermatology. “We wanted to shed light on the fact that the ‘clean beauty’ movement is more of a business model and marketing tool that plays on the trend of people wanting to use natural rather than synthetic products right now,” said Dr. Bruce Brod of the University of Pennsylvania in Philadelphia, who co-wrote the editorial. “Instead, we need to take a more balanced approach when choosing which products to use on our skin,” Brod said in a phone interview. Between 2017 and 2018, the natural skin care market grew by 23% to $1.6 billion, accounting for about a quarter of the $5.6 billion annual skin care sales in 2018, Brod and co-author Dr. Courtney Blair Rubin, also a dermatologist in Philadelphia, point out. Brod said they decided to write the editorial after seeing a trend in recent years of patients reporting allergic reactions to natural beauty products. Every few weeks, they see new cases of contact dermatitis, or itchy rashes that pop up on the face and hands, he said, which are linked to botanical or natural ingredients in beauty products. “Many of these products are marketed and sold to consumers who are misled to think the products are superior,” he told Reuters Health. “We support free enterprise but want to make sure patients have all the available knowledge at their fingertips and choose products with their eyes wide open.” Brod and Rubin note that some chemicals in traditional products are “demonized” without proof they’re unsafe. Wellness and lifestyle blogs have ignited fear among consumers, who are calling for safe and nontoxic beauty products, Brod and Rubin write. However, the US Food and Drug Administration doesn’t define “clean” or “natural,” which leaves the labels open to interpretation. And in an effort to go “green,” many companies and retailers have released lists of ingredients that shouldn’t be used. For instance, Whole Foods’ 2018 list of unacceptable ingredients, which includes more than 400 compounds, included petrolatum, which dermatologists recommend to patients because it is so nonallergenic. Plus, it’s cheap and accessible for people of all backgrounds. Similarly, the Campaign for Safe Cosmetics tells consumers to avoid parabens, which the American Contact Dermatitis Society named the 2019 “nonallergen of the year.” Parabens have some of the lowest rates of allergic reactions, between 0.5% and 1.4% of users, the authors note. “The commercial personal care products industry is accountable to high standards,” Brod said. “Products that include synthetic ingredients are created to prevent those adverse reactions on the skin, and preservatives are meant to prevent those complications.” On the other hand, many natural products contain high concentrations of botanical extracts that cause rashes and allergies, particularly perfumes, creams, lotions and aromatherapy that tout essential oils, Joel DeKoven of the University of Toronto said by phone. “We’ve seen horrible reactions from kids being exposed to undiluted oils,” said DeKoven, who wasn’t involved in the editorial. “There’s no guarantee about the efficacy and safety of these products, which you’d think would be everyone’s concern if they really thought about it.” Koven belongs to the North American Contact Dermatitis Group, comprised of dermatologists who report patch test results on patients with skin allergies to a composite database. They then analyze the data for trends. Methylisothiazolinone, a preservative often used in place of parabens in personal care products that are trying to be “paraben-free,” continues to show the highest rates of allergic reactions, he noted. “Poison ivy is natural, arsenic is natural, and poisonous mushrooms are natural, so the term ‘natural’ doesn’t carry the mystique or cachet from a scientific point of view,” DeKoven said. “What we’re concerned about as dermatologists is the safety of the products that consumers are interested in, as well as what it costs.”