1071
preparations on the market contain ranging from 0.26 to 3-13% (Morgans’ perfumed pomade 3-13%, Morgan’s pomade 2-71%, ’Formula 16’ 0.26%, ’Restoria’ cream 0.37%, ’NoMoR Grey’ 0-75%, ’Grecian 2000’ 0.82%). Only the Morgan’s pomades state on the label (albeit obliquely) that the product contains lead acetate. All the products carry some warnings, on the label or in the instruction leaflet, to the effect that the hands must be washed after use, that the product should not be used if the skin is broken or abraded, and that it should be kept Other hair-darkening lead acetate in amounts
away from children.
The concentration of lead in hair care products must not exceed 3% (Cosmetic Products Regulations 1978; SI 1978 no. 1354). The regulations also require that the following instructions are given: wash hands after use; do not use on broken or abraded skin; keep out of reach of children. There is no requirement to state that the products contain lead. Moreover, these regulations do not have effect for retail sale until after
July 29,1981. It seems clear, however, that these products may pose a serious threat of lead poisoning in young children and that the manufacturers should be obliged to state this unequivocally on the label. To bury a warning on the instruction leaflet inside the pack is not sufficient. Most parents have been made aware of the need to keep medicines out of reach of their children; they should also be made aware of the need to take similar precautions with cosmetics. I thank Mr A. Archer and his staff at the City of Birmingham environmental health department for their help and Mr A. H. Coombes for the chemical analyses of hair care products. This work is part of the survey being undertaken under the auspices of the Steering Committee on Environmental Lead. London School of Hygiene and Tropical Medicine, London WC1E 7HT
H. A. WALDRON
NALOXONE: NON-STEROIDAL TREATMENT FOR POSTMENOPAUSAL FLUSHING?
SIR,-Although about 85% of women experience attacks of flushing and sweating at some time’ the cause of this vasomotor instability is poorly understood.2 Treatment with cestrogen provides the only satisfactory remedy. Infusion of an enkephalin analogue causes severe facial flushing,3 and naloxone, a pure opiate antagonist, inhibits the chlorpropramideinduced alcoholic flushing of diabetics and the flushing caused by infusion of the enkephalin analogue.’ We have investigated the effect of infusion of naloxone on postmenopausal flushing. who had had severe and frequent postmenopausal for between 10 months and 25 years all gave informed consent to the study. They were admitted to a metabolic ward on the day before the start of investigations. On the following day, a 19 g cannula was inserted into an antecubital vein. A record of flushes was kept by the nurses, who were called to each flushing episode. On the next morning an infusion pump was set up and naloxone or saline was infused and a flush chart was kept as on the previous day. The day was divided into eight periods of 90 min. Four of these periods were allocated to infusions of naloxone (22.2 ug,/min) and four to infusions of the same volume of physiological saline. The order of these eight infusions had been randomised before the study and the contents of the syringes used for the infusions were unknown to the patient, the nurses, or the doctor overseeing the infusions. The contents of the syringes (40 ml) were infused at a rate of 26-7 7 ml/h so each infusion took 90 min. Four
women
flushing
1. Sanes KI. Hot flushes systems as factors
of menopause The vegetative, nervous, and endocrine or
menopause disturbance. Trans Am Assoc Obstet
Gynecol 1920; 32: 182-210. 2. Mulley G, Mitchell JRA. Menopausal flushing: Does œstrogen therapy make sense? Lancet 1976; i: 1397-99. 3. Stubbs WA, Jones A, Edwards CRW, Delitala G, Jeffcoate WJ, Ratter SJ, Besser GM, Bloom SR, Alberti KGMM. Hormonal and metabolic responses to an enkephalin analogue in normal man. Lancet 1978; ii: 1225-27. 4. Leslie
RDG, Pyke DA, Stubbs WA. Sensitivity to enkephalin non-insulin dependent diabetes. Lancet 1979; i: 341-43.
as a cause
of
DAY1
Flushing day (day 2).
attacks
Time ofdoy
(vertical bars)
on
control
DAY2
day (day 1)
and
study
The flushing attacks are shown in the figure. The four patients had 34 flushing episodes on the control day between 10 A.M. and 10 P.M. and 21 episodes between the same times during the treatment day. However, on the treatment day there were 16 flushes during the four 90 min placebo periods but only 5 during the naloxone periods. (p
preparations on the market contain ranging from 0.26 to 3-13% (Morgans’ perfumed pomade 3-13%, Morgan’s pomade 2-71%, ’Formula 16’ 0.26%, ’Restoria’ cream 0.37%, ’NoMoR Grey’ 0-75%, ’Grecian 2000’ 0.82%). Only the Morgan’s pomades state on the label (albeit obliquely) that the product contains lead acetate. All the products carry some warnings, on the label or in the instruction leaflet, to the effect that the hands must be washed after use, that the product should not be used if the skin is broken or abraded, and that it should be kept Other hair-darkening lead acetate in amounts
away from children.
The concentration of lead in hair care products must not exceed 3% (Cosmetic Products Regulations 1978; SI 1978 no. 1354). The regulations also require that the following instructions are given: wash hands after use; do not use on broken or abraded skin; keep out of reach of children. There is no requirement to state that the products contain lead. Moreover, these regulations do not have effect for retail sale until after
July 29,1981. It seems clear, however, that these products may pose a serious threat of lead poisoning in young children and that the manufacturers should be obliged to state this unequivocally on the label. To bury a warning on the instruction leaflet inside the pack is not sufficient. Most parents have been made aware of the need to keep medicines out of reach of their children; they should also be made aware of the need to take similar precautions with cosmetics. I thank Mr A. Archer and his staff at the City of Birmingham environmental health department for their help and Mr A. H. Coombes for the chemical analyses of hair care products. This work is part of the survey being undertaken under the auspices of the Steering Committee on Environmental Lead. London School of Hygiene and Tropical Medicine, London WC1E 7HT
H. A. WALDRON
NALOXONE: NON-STEROIDAL TREATMENT FOR POSTMENOPAUSAL FLUSHING?
SIR,-Although about 85% of women experience attacks of flushing and sweating at some time’ the cause of this vasomotor instability is poorly understood.2 Treatment with cestrogen provides the only satisfactory remedy. Infusion of an enkephalin analogue causes severe facial flushing,3 and naloxone, a pure opiate antagonist, inhibits the chlorpropramideinduced alcoholic flushing of diabetics and the flushing caused by infusion of the enkephalin analogue.’ We have investigated the effect of infusion of naloxone on postmenopausal flushing. who had had severe and frequent postmenopausal for between 10 months and 25 years all gave informed consent to the study. They were admitted to a metabolic ward on the day before the start of investigations. On the following day, a 19 g cannula was inserted into an antecubital vein. A record of flushes was kept by the nurses, who were called to each flushing episode. On the next morning an infusion pump was set up and naloxone or saline was infused and a flush chart was kept as on the previous day. The day was divided into eight periods of 90 min. Four of these periods were allocated to infusions of naloxone (22.2 ug,/min) and four to infusions of the same volume of physiological saline. The order of these eight infusions had been randomised before the study and the contents of the syringes used for the infusions were unknown to the patient, the nurses, or the doctor overseeing the infusions. The contents of the syringes (40 ml) were infused at a rate of 26-7 7 ml/h so each infusion took 90 min. Four
women
flushing
1. Sanes KI. Hot flushes systems as factors
of menopause The vegetative, nervous, and endocrine or
menopause disturbance. Trans Am Assoc Obstet
Gynecol 1920; 32: 182-210. 2. Mulley G, Mitchell JRA. Menopausal flushing: Does œstrogen therapy make sense? Lancet 1976; i: 1397-99. 3. Stubbs WA, Jones A, Edwards CRW, Delitala G, Jeffcoate WJ, Ratter SJ, Besser GM, Bloom SR, Alberti KGMM. Hormonal and metabolic responses to an enkephalin analogue in normal man. Lancet 1978; ii: 1225-27. 4. Leslie
RDG, Pyke DA, Stubbs WA. Sensitivity to enkephalin non-insulin dependent diabetes. Lancet 1979; i: 341-43.
as a cause
of
DAY1
Flushing day (day 2).
attacks
Time ofdoy
(vertical bars)
on
control
DAY2
day (day 1)
and
study
The flushing attacks are shown in the figure. The four patients had 34 flushing episodes on the control day between 10 A.M. and 10 P.M. and 21 episodes between the same times during the treatment day. However, on the treatment day there were 16 flushes during the four 90 min placebo periods but only 5 during the naloxone periods. (p
