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Abstract
BACKGROUND Minimally invasive cosmetic procedures are on the rise. To meet this rising demand, increasing numbers of physicians and nonphysicians are performing these procedures. Understanding malpractice trends and reasons for litigation in cosmetic medicine is important to establish safeguards for patient care and minimize liability. OBJECTIVE Perform a comprehensive review of the literature on litigation associated with minimally invasive cosmetic procedures and discuss strategies to avoid facing a lawsuit. MATERIALS AND METHODS The authors searched PubMed databases using a variety of keywords to identify studies of lawsuits arising from minimally invasive cosmetic procedures through December 2020. RESULTS A total of 12 studies of litigation meeting inclusion criteria were identified: botulinum toxin (1), soft tissue fillers (3), lasers (5), body contouring/liposuction (1), chemical peels/dermabrasion (1), and sclerotherapy (1). Principle factors associated with litigation included negligence, lack of informed consent, vicarious liability for action of delegates, lack of communication, poor cosmetic result, failure to inform of risks, inappropriate treatment or dose, and failure to recognize or treat injury. CONCLUSION Understanding malpractice trends and reasons for litigation in minimally invasive cosmetic procedures can strengthen the patient-provider relationship, establish safeguards for patient care, and may minimize future risk of a lawsuit.
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Affiliation(s)
- Brian P Hibler
- Department of Dermatology, Dermatology Laser and Cosmetic Center, Massachusetts General Hospital, Boston, Massachusetts
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Karen C Kagha
- Department of Dermatology, Dermatology Laser and Cosmetic Center, Massachusetts General Hospital, Boston, Massachusetts
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mathew M Avram
- Department of Dermatology, Dermatology Laser and Cosmetic Center, Massachusetts General Hospital, Boston, Massachusetts
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Pistollato F, Madia F, Corvi R, Munn S, Grignard E, Paini A, Worth A, Bal-Price A, Prieto P, Casati S, Berggren E, Bopp SK, Zuang V. Current EU regulatory requirements for the assessment of chemicals and cosmetic products: challenges and opportunities for introducing new approach methodologies. Arch Toxicol 2021; 95:1867-1897. [PMID: 33851225 PMCID: PMC8166712 DOI: 10.1007/s00204-021-03034-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/18/2021] [Indexed: 12/28/2022]
Abstract
The EU Directive 2010/63/EU on the protection of animals used for scientific purposes and other EU regulations, such as REACH and the Cosmetic Products Regulation advocate for a change in the way toxicity testing is conducted. Whilst the Cosmetic Products Regulation bans animal testing altogether, REACH aims for a progressive shift from in vivo testing towards quantitative in vitro and computational approaches. Several endpoints can already be addressed using non-animal approaches including skin corrosion and irritation, serious eye damage and irritation, skin sensitisation, and mutagenicity and genotoxicity. However, for systemic effects such as acute toxicity, repeated dose toxicity and reproductive and developmental toxicity, evaluation of chemicals under REACH still heavily relies on animal tests. Here we summarise current EU regulatory requirements for the human health assessment of chemicals under REACH and the Cosmetic Products Regulation, considering the more critical endpoints and identifying the main challenges in introducing alternative methods into regulatory testing practice. This supports a recent initiative taken by the International Cooperation on Alternative Test Methods (ICATM) to summarise current regulatory requirements specific for the assessment of chemicals and cosmetic products for several human health-related endpoints, with the aim of comparing different jurisdictions and coordinating the promotion and ultimately the implementation of non-animal approaches worldwide. Recent initiatives undertaken at European level to promote the 3Rs and the use of alternative methods in current regulatory practice are also discussed.
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Affiliation(s)
- Francesca Pistollato
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Federica Madia
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Raffaella Corvi
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Sharon Munn
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Elise Grignard
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Alicia Paini
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Andrew Worth
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Anna Bal-Price
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Pilar Prieto
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Silvia Casati
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Elisabet Berggren
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Stephanie K Bopp
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy
| | - Valérie Zuang
- Directorate F-Health, Consumers and Reference Materials, Unit F3 Chemicals Safety and Alternative Methods, European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP126, 21027, Ispra, VA, Italy.
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Bilia AR, Costa MDC. Medicinal plants and their preparations in the European market: Why has the harmonization failed? The cases of St. John's wort, valerian, ginkgo, ginseng, and green tea. Phytomedicine 2021; 81:153421. [PMID: 33291029 DOI: 10.1016/j.phymed.2020.153421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 11/09/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Botanical ingredients based on plants, algae, fungi or lichens have become widely available on the European Union market offering numerous preparations with considerable differences in classification. They are under the categories of food supplements, herbal medicinal products, cosmetics or medical devices. PURPOSE The aim of the present work is to highlight how the European regulations concerning the different categories of botanicals can lead to different commercial choices such as time/cost for product development, application for a marketing authorisation, permitted indication (medical or health claim), and as a consequence, the same botanical products are sold in European Union as herbal medicinal products, food supplements, cosmetics or medical devices. Five different widely used botanicals, namely St. John's wort, valerian, ginkgo, ginseng, and green tea were selected to better explain the failure of harmonization through European Union. METHODS A search of PubMed, ScienceDirect, European Medicines Agency and European commission web sites for medical devices and cosmetics, and European Food Safety Authority websites were conducted and the available information on regulation of herbal medicinal products, food supplements, medical devices and cosmetics in the European Union was collected. In addition, a market survey of all the sold botanical products in Europe was analysed by consultation of the medicines, medical devices, cosmetic and food agencies websites of the European countries. RESULTS The current European legislation needs implementation and follow up because in the different countries the legal positions of the botanical products varied and it is possible to find the same product classified in the different categories, namely registered medicinal product including prescription only medicine, traditional herbal medicinal product, well established herbal medicinal products or food supplement, or medical device, or homoeopathic/anthroposophical medical product, cosmetic. CONCLUSIONS There is an urgent need of harmonization, together with the implementation of interoperable vigilance databases, to avoid borderline options.
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Affiliation(s)
- Anna Rita Bilia
- Department of Chemistry "Ugo Schiff", via Ugo Schiff 6, 50019 Sesto Fiorentino, Florence, Italy.
| | - Maria do Céu Costa
- CBIOS, Universidade Lusófona's Research Center for Biosciences & Health Technologies, Campo Grande, 376, 1749-024 Lisboa, Portugal; NICiTeS, Instituto Politécnico de Lusofonia, Rua do Telhal aos Olivais, n8 - 8a, 1950-396 Lisboa Portugal
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Shen NT, Yuan H, Lin QB, Tang L. [Mandatory regulations and standards regarding cosmetic botanic ingredients in major countries and regions]. Zhongguo Zhong Yao Za Zhi 2019; 44:5488-5495. [PMID: 32237399 DOI: 10.19540/j.cnki.cjcmm.20191025.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cosmetics containing botanic ingredients have been used from thousands of years up to now in China. Because of the consumers' demand for health and beauty,the number of products about " botanic" have been growing rapidly in the cosmetics market,which has played an important role in upgrading the industry and enhancing the international competitiveness nowadays. Therefore,to strengthen the management about used botanic raw materials in cosmetics products and revise the application regulation of new raw materials has become an important work to ensure product quality,promote the healthy and stable development of cosmetic business. The article summarizes the related mandatory regulations and standards about botanic ingredients which used as activity function in major cosmetic business countries or regions. Furthermore,the information of botanic ingredients commonly used in non-special cosmetics notification and special cosmetic registration system were described to expect the better application and development.
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Affiliation(s)
- Nai-Tao Shen
- the Fourth Affiliated Hospital of School of Medicine,Zhejiang University Yiwu 322000,China
| | - Huan Yuan
- National Institutes for Food and Drug Control Beijing 100050,China
| | - Qing-Bin Lin
- Academy of Military Medicine,Academy of Military Sciences Beijing 100039,China
| | - Lin Tang
- Zhejiang Pharmaceutical College Ningbo 315100,China
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Michalek IM, Benn EKT, Dos Santos FLC, Gordon S, Wen C, Liu B. A systematic review of global legal regulations on the permissible level of heavy metals in cosmetics with particular emphasis on skin lightening products. Environ Res 2019; 170:187-193. [PMID: 30583128 DOI: 10.1016/j.envres.2018.12.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/13/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND There is an urgent need to address the safety problems caused by the use of skin lightening cosmetics. Evidence suggests that some of them may contain heavy metals. OBJECTIVES We conducted a systematic review of global legal regulations regarding the permissible level of mercury, lead, arsenic, and cadmium in cosmetic products, with particular emphasis on skin lightening preparations. METHODS The systematic search of documents was a two-stage process. First, official websites of 17 regional organizations and subsequently regulations for countries with a population over 100 million were searched. RESULTS Fifteen legislative acts, encompassing more than 67·2% of the global population were reviewed. Regulations were identified for 44/59 high income countries, 16/55 upper middle income countries, 9/45 lower income countries, 0/34 low income countries. The median adult literacy rate was 91·4% and 64·2% in countries with and without regulations, respectively. The use of mercury, lead, arsenic, and cadmium has been banned in 67, 67, 65, and 65 out of 69 countries, respectively. CONCLUSIONS While regulations exist in most of the high income countries, in low income countries there is a lack of similar standards. In most countries for which these legal regulations have been identified, restrictions on the permissible level of heavy metals are strict. There is a need for enforcement of existing rules, and rigorous assessment of the effectiveness of these regulations.
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Affiliation(s)
| | - Emma K T Benn
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Sharon Gordon
- Community Engagement Core, P30 Pilot Study, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Chi Wen
- Master of Public Health Program, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bian Liu
- Institute for Translational Epidemiology, Institute for Exposomic Research, Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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