Jurnal Paru kerja Kepada yth :

Pengaruh Bedak Serbuk Kosmetik terhadap Kesehatan

Presentan : dr. Hafis Herdiman

Hari/tanggal : Selasa/23 Februari 2020
Tempat : Ruang Konfren Bagian Pulmonologi
Pembimbing : dr.Deddy Herman ,Sp.P (K),FISR,FAPSR
Dr.dr. Masrul Basyar, Sp.P (K),FISR,FAPSR
dr. Yenni Muchtar,Sp.P
opponent :

BAGIAN PULMONOLOGI DAN KEDOKTERAN RESPIRASI

FAKULTAS KEDOKTERAN UNIVERSITAS ANDALAS/

RSUP DR. DJAMIL PADANG

2021
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Review Article

The Effect of Cosmetic Talc Powder on Health

Khaled Ali Al Awam, Saumy Johnson, Afaf Alonazi, Amjad Abo Aleeh, Afnan Aldhamen, Anwar Alhaddad, Salma Alnouf, Faten Almutairi, Rawan Zila,
Reema Algoud, Dania Alghurab, Mona Alsayegh, Batool Alnakli
Department of Respiratory Therapy Sciences, Inaya Medical College, Riyadh, Saudi Arabia

Abstract
Talc powder is widely used for different purposes worldwide. Effects of talc on the human health is a concern as it has many chemical
components. This review is an attempt to present the relevant researches in this field and to summarize the current updates about the topic.
Talcum powder exposure has been shown to be a reason in the development of mesotheliomas and carcinoma of the lung in women.
Regular cosmetic powders can get attached to larger particles that would deposit in the upper airways of the human respiratory system. The
alveolar region is the second most exposed region of the respiratory system. Deposition levels in the tracheobronchial region is the lowest.
Cosmetic talc powder, used regularly by women worldwide, can cause detrimental effects on different organ systems of the human body.
Awareness on its harmful effects to the users may be useful to reduce the usage to some extent.

Keywords: Pleurodesis, pulmonary diseases, talc powder

INTRODUCTION to add an attractive aroma and presentation to the customers.

Talc belongs to the general mineral family of the layered
silicates which are present in nature and are composed of
crystalline hydrous magnesium silicate. In combination with
magnesite, it is available worldwide. It is also possible to
find pure talc. Commercial use is possible after sorting
where talc crystals are milled or micronized to fine powders.
Talc structure is soft and chemically inactive with bright
white color in general. Its color may be changed by staining
with iron or impurity by other minerals. It is not specifically
deemed dangerous and is classified as an irritant dust in
powder form.[1]
Two types of talc, industrial and cosmetic, are used in paper,
plastics, rubber, paint, and cosmetic manufacturing work. [2,3]
Furthermore, these substances have been shown to be
effective for use through tube thoracostomy. These include
cosmetic talc and iodopovidone. These are considered to be
safe.[4] Cosmetic powder is packaged as a compact powder or
a loose powder, which is used for makeup, and contains
heavy metals such as Cd, Co, Pb, Cu, and Cr. A study on
thirty different brands of talcum powder showed that metals
are present in safe limits, but the excess use of talcum
powder affects the health of the consumer.[5] Some studies
have shown that exposure to cosmetic talc grades is
considered to be much lower than in talc mills and mines.[3]
Preservatives and fragrances are added to cosmetic products
Cosmetic powders are of poor antimicrobiological quality.
They may be the sources for microorganisms to grow and
are more contaminated with fungi than with bacteria. Some
chemical compounds are added to avoid the microbial
growth. However, microorganisms may cause damage or
chemical changes in cosmetic products.[5-8] A few of the
components in the cosmetics can enter the skin and might
cause systemic effects.[9]
In 2005, a study was done on several facial cosmetics
available in Nigeria and it showed that the regular use of
cosmetics might end up in escalation in the quantity of trace
metal in the human body beyond the safety range, especially
in ocular system.[10,11] In 2012, the first case of severe
endobronchitis using talcum powder was reported in a
female patient.[12]
A study on rats was done by Shim et al. on talc involving
both male and female Sprague-Dawley rats with recurrent
4 weeks of toxicity through the inhalational route to the
whole body. Rats were given the trial of talc (inhaled) in
different concentrations such as 0, 5, 50, and 100 mg/m3 for
Address for correspondence: Dr. Khaled Ali Al Awam,
Respiratory Therapy Program, Inaya Medical College, P. O. Box: 271880,
Riyadh 11352, Saudi Arabia.
E-mail: kalawam@inaya.edu.sa

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Website:
www.ijrconline.org How to cite this article: Al Awam KA, Johnson S, Alonazi A, Aleeh
AA, Aldhamen A, Alhaddad A, et al. The effect of cosmetic talc powder
on health. Indian J Respir Care 2019;8:18-21.
DOI:
10.4103/ijrc.ijrc_24_18

18 © 2019 Indian Journal of Respiratory Care | Published by Wolters Kluwer ‑ Medknow

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Al Awam, et al.: Effect of cosmetic talc powder
6 h/day, for 5 days a week, for 4 weeks. The study reported
no adverse events or death of the rats that were exposed to
talc. A reduction in glucose was seen in male rats exposed
to 50 and 100 mg/m3 of talc. Furthermore, insinuation of
macrophages both in the walls of the alveoli and spaces
adjacent to the terminal and respiratory bronchioles was
observed during histopathological analysis. Superoxide
dismutase 2, a classic genetic sign of oxidative damage, was
present in both male and female rats exposed to 100 mg/m 3
talc. They concluded that macrophage aggregations were
prompted by the inhalation of talc. In fact, damage to the
lung could be attributed to the oxidative stress.[13]
TALC AND PULMONARY DISEASES
Talc causes four types of pulmonary diseases; three
associated with aspiration (talcosilicosis, talcoasbestosis,
and talcosis) and one by intravenous administration of talc.
The latter is seen in drug abusers who inject medications
intended for oral use. Indicatives of pulmonary talcosis seen
by high-resolution computed tomography (CT) showed
small centrilobular nodules associated with heterogeneous
conglomerate masses. These consist of high-density
amorphous areas, with or without panlobular emphysema in
the lower lobes. Histopathologic studies in a case report
showed the presence of birefringent, needle-shaped particles
of talc inside the giant cells with areas of pulmonary fibrosis
associated with the use of polarized light in talc
pneumoconiosis. The authors concluded that CT plays a
vital role in the diagnosis of pulmonary talcosis, as
indicative configurations may be seen. [14] If this kind of pattern
is seen in patients with a history of contact with talc or in
drug abuser, it is greatly indicative of pulmonary talcosis as
shown in Figure 1a and b.[2]
PATHOPHYSIOLOGY
The pathophysiology of talcosis may be similar to that of
sarcoidosis. Talc granulomatosis is classically associated
with high concentrations of serum anticholinesterase and a SAFER USE OF TALC
large number of lymphocytes in bronchoalveolar lavage. A Talc is used in the treatment of idiopathic spontaneous
person who has sarcoidosis must go through a pneumothorax although it might result in a mild restrictive
comprehensive interview about exposure to organic or
inorganic dusts. Corticosteroids in the treatment modality
reduce symptoms Table 1: Several studies outlining the effects of talc powder on health
Figure 1: (a and b) Dense consolidation at the level of the main bronchi,
with dilated bronchi, pericicatricial ab
emphysematous changes (arrows),
ground-glass opacities, and interlobular septal thickening (arrowheads)
in the upper lobe of both lungs seen by axial thin section computed
tomography scan (1.5-mm-thick section) in a patient who worked for
8 years in the processing of magnesium silicate
and improve pulmonary function, though the possibility of
relapse exists after the completion of treatment.
Substantial similarity in signs and symptoms and imaging
and laboratory parameters among patients presenting with
pulmonary fibrosis requires a detailed interview and will be
the key to identification of the disease.
Shinno et al. presented a case series of acute respiratory
distress syndrome (ARDS) subsequent to pleurodesis with
macroparticle size talc (2018). They found out that advance
in the age and presence of any interstitial changes in the
lung as shown in CT of the chest are the likely risk elements
for the presence of posttalc pleurodesis-ARDS.[15,16] Some
studies showed successful talc pleurodesis outcomes in
patients with abundant malignant pleural effusion by using
pleurodesis with thoracoscopic talc insufflations or with talc
slurry instillation with similar success rate.[17] Success
depends on several factors including female gender,
Karnofsky Performance Score >70, pleural fluid pH ≥7.34,
adenosine deaminase ≥18 IU/l, and pleural fluid cholesterol
≤82 mg/dl.[18,19]
A study done in Germany showed a positive association
between asbestos, talc, carcinoma of the lung, laryngeal
carcinoma, and carcinoma of the stomach among rubber
workers. Deaths from noncarcinomatous pulmonary diseases
also increased when exposed to talc.[17,18] Long-term
exposure to talc powder may cause chronic bronchitis and
pneumocystis.[20-22]
Talcum powder exposure has been shown to be a reason in
the development of mesotheliomas and carcinoma of the
lung in women.[23,24] Exposure to talc free of silica and asbestos
causes both pneumoconiosis and chronic respiratory
impairment. There are many researches on the effects of talc
on different organ systems [Table 1]. Miners and millers
exposed to talc free of asbestos and silica developed
obstructive pulmonary effects.[25]
Researches Effect of talc on health
Frank C[15] Pulmonary talcosis
Shinno et al.[16] ARDS, ALI
Yildirim et al.[19] Chronic bronchitis
Straif et al.[20] Pneumocystis, pneumoconiosis
Wild et al.[21] Lung cancer and laryngeal cancer
Hildick-Smith[32]
Wegman et al.[25] Ovarian cancer
Karageorgi et al.[33] Endometrial cancer risk
Kuzniar et al.[31] Severe hypoxemia
Genofre et al.[8] Inflammatory response
Lange et al.[24] Impairment of lung function and pleural thickening
ARDS: Acute respiratory distress syndrome, ALI: Acute lung injury
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Al Awam, et al.: Effect of cosmetic talc powder
impairment of lung function and pleural thickening as seen
in the chest X-ray.[24]
There are articles in the literature which conclude that talc
is not harmful. Genes GSTM1 and GSTT1 in women can be
varied and this variation is found to affect the association of
the use of genital talc and the risk of ovarian cancer. [26] An
analysis of authentic historical Italian cosmetic talc sample
by Ilgren et al. through selected area electron diffraction
combined with energy dispersive X-ray analysis found that
Pinerolo Italian cosmetic talc does not cause any cancer risk,
which is due to its purity.[27,28] Similarly, French and Austrian
talc workers were examined for the effects of talc dust on
respiratory system using pulmonary function test and chest
X-ray, but neither showed any evidence of detrimental
effects of talc exposure.[29]
Regular cosmetic powders can get attached to larger
particles that would deposit in the upper airways of the
human respiratory system. The alveolar region was the
second most exposed region of the respiratory system.
Deposition levels in the tracheobronchial region were the
lowest. Both routinely mixed and small talc particles result
in an inflammatory response. Both types of particles were
seen to be deposited in the lungs, spleen, liver, and kidneys
of animal studies.[30] The medical thoracoscopic talc
pleurodesis is an analgesic and useful remedy for malignant
pleural effusion.[31] Use of talc powder in the perineal area is
shown to increase the chance of endometrial cancer. This is
more prevalent among post- menopausal women.[33]
CONCLUSION
Cosmetic talc powder, used regularly by women worldwide,
can cause detrimental effects on different organ systems of
the human body. Awareness on its harmful effects to the
users may be useful to reduce the usage to some extent.
Further research is needed to obtain more evidence
regarding its effects on the pulmonary system.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. McCarthy E. Talc. Kirk-Othmer Encyclopedia of Chemical
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https://www.doi.org/10.1002/0471238961.20011 20313030301.a01.
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2. Marchiori E, Lourenço S, Gasparetto TD, Zanetti G, Mano CM,
Nobre LF, et al. Pulmonary talcosis: Imaging findings. Lung
2010;188:165-71.
3. Choosong T, Phakthongsuk P. Health status of workers exposed to
talcum powder in hospitals in Southern Thailand. Aerosol Air Qual
Res 2006;6:397-405.
4. Agarwal R, Paul AS, Aggarwal AN, Gupta D, Jindal SK. A
randomized controlled trial of the efficacy of cosmetic talc compared
with iodopovidone for chemical pleurodesis. Respirology
2011;16:1064-9.
5. Rehman G, Bukhari IH, Riaz M, Manzoor HS, Rasool N, Khalid A,
et al. Determination of toxic heavy metals in different brands of talcum
powder. Int J Appl Nat Sci 2013;2:45-52.
6. Chen J, Li Z, Xu N, Zhang X, Wang Y, Lin D, et al. Efficacy of
medical thoracoscopic talc pleurodesis in malignant pleural effusion
caused by different types of tumors and different pathological
classifications of lung cancer. Int J Clin Exp Med 2015;8:18945-53.
7. SI SN, Praveena SM. Hazardous ingredients in cosmetics and personal
care products and health concern: A review. Public Health Res
2015;5:7-15.
8. Genofre EH, Vargas FS, Acencio MM, Antonangelo L, Teixeira LR,
Marchi E, et al. Talc pleurodesis: Evidence of systemic inflammatory
response to small size talc particles. Respir Med 2009;103:91-7.
9. Dashen MM, Chollom PF, Okechalu JN, Ma’aji JA. Microbiological
quality assessment of some brands of cosmetics powders sold within
Jos metropolis, plateau state. J Microbiol Biotechnol Res
2017;1:101-6.
10. Nouioui MA, Mahjoubi S, Ghorbel A, Ben Haj Yahia M, Amira D,
Ghorbel H, et al. Health risk assessment of heavy metals in traditional
cosmetics sold in Tunisian local markets. Int Sch Res Notices
2016;2016:6296458.
11. Nnorom IC, Igwe JC, Oji-Nnorom CG. Trace metal contents of facial
(make-up) cosmetics commonly used in Nigeria. Afr J Biotechnol
2005;4:1133-8.
12. Ong TH, Takano A. Severe endobronchitis and airway stricture caused
by inhalation of cosmetic talc. Chest 2012;142:511-3.
13. Shim I, Kim HM, Yang S, Choi M, Seo GB, Lee BW, et al. Inhalation
of talc induces infiltration of macrophages and up regulation of
manganese superoxide dismutase in rats. Int J Toxicol 2015;34:491-9.
14. Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS, et al.
Pneumoconiosis: Comparison of imaging and pathologic findings.
Radiographics 2006;26:59-77.
15. Frank C, Jorge L. An uncommon hazard: Pulmonary talcosis as a result
of recurrent aspiration of baby powder. Respir Med 2011;4:109-11.
16. Shinno Y, Kage H, Chino H, Inaba A, Arakawa S, Noguchi S, et al.
Old age and underlying interstitial abnormalities are risk factors for
development of ARDS after pleurodesis using limited amount of large
particle size talc. Respirology 2018;23:55-9.
17. Rehse DH, Aye RW, Florence MG. Respiratory failure following talc
pleurodesis. Am J Surg 1999;177:437-40.
18. Debeljak A, Kecelj P, Triller N, Letonja S, Kern I, Debevec L, et al.
Talc pleurodesis: Comparison of talc slurry instillation with
thoracoscopic talc insufflation for malignant pleural effusions. J BUON
2006;11:463-7.
19. Yildirim H, Metintas M, Ak G, Metintas S, Erginel S. Predictors of talc
pleurodesis outcome in patients with malignant pleural effusions. Lung
Cancer 2008;62:139-44.
20. Straif K, Keil U, Taeger D, Holthenrich D, Sun Y, Bungers M, et al.
Exposure to nitrosamines, carbon black, asbestos, and talc and
mortality from stomach, lung, and laryngeal cancer in a cohort of
rubber workers. Am J Epidemiol 2000;152:297-306.
21. Wild P, Leodolter K, Réfrégier M, Schmidt H, Zidek T, Haidinger G,
et al. A cohort mortality and nested case-control study of French and
Austrian talc workers. Occup Environ Med 2002;59:98-105.
22. Wild P, Réfrégier M, Auburtin G, Carton B, Moulin JJ. Survey of the
respiratory health of the workers of a talc producing factory. Occup
Environ Med 1995;52:470-7.
23. Gordon RE, Fitzgerald S, Millette J. Asbestos in commercial cosmetic
talcum powder as a cause of mesothelioma in women. Int J Occup
Environ Health 2014;20:318-32.
24. Lange P, Mortensen J, Groth S. Lung function 22-35 years after
treatment of idiopathic spontaneous pneumothorax with talc poudrage
or simple drainage. Thorax 1988;43:559-61.
25. Wegman DH, Peters JM, Boundy MG, Smith TJ. Evaluation of
respiratory effects in miners and millers exposed to talc free of
asbestos and silica. Br J Ind Med 1982;39:233-8.
26. Gates MA, Tworoger SS, Terry KL, Titus-Ernstoff L, Rosner B,
De Vivo I, et al. Talc use, variants of the GSTM1, GSTT1, and
NAT2 genes, and risk of epithelial ovarian cancer. Cancer Epidemiol
Biomarkers Prev 2008;17:2436-44.
27. Ilgren EB, Sartorio C, Hoskins J. Analysis of an authentic historical
Italian cosmetic talc sample–further evidence for the lack of cancer
risk. Environ Pollut 2017;6:6.
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Al Awam, et al.: Effect of cosmetic talc powder

28. Anderson EL, Sheehan PJ, Kalmes RM, Griffin JR. Assessment of
cosmetic powders. Environ Health Perspect 2012;120:885-92.
health risk from historical use of cosmetic talcum powder. Risk Anal
31. Kuzniar TJ, Blum MG, Kasibowska-Kuzniar K, Mutlu GM. Predictors
2017;37:918-29.
of acute lung injury and severe hypoxemia in patients undergoing
29. Wild P, Leodolter K, Réfrégier M, Schmidt H, Bourgkard E. Effects
operative talc pleurodesis. Ann Thorac Surg 2006;82:1976-81.
of talc dust on respiratory health: Results of a longitudinal survey
32. Hildick-Smith GY. The biology of talc. Occup Environ Med
of 378 French and Austrian talc workers. Occup Environ Med
1976;33:217-29.
2008;65:261-7.
33. Karageorgi S, Gates MA, Hankinson SE, De Vivo I. Perineal use
30. Nazarenko Y, Zhen H, Han T, Lioy PJ, Mainelis G. Potential for
of talcum powder and endometrial cancer risk. Cancer Epidemiol
inhalation
Biomarkers Prev 2010;19:1269-75.
exposure to engineered nanoparticles from nanotechnology-based

Indian Journal of Respiratory Care ¦ Volume 8 ¦ Issue 1 ¦ January-June 2019 21

 Pengaruh Bedak Serbuk Kosmetik terhadap Kesehatan

Abstrak

Bedak serbuk telah digunakan secara luas untuk berbagai tujuan di seluruh dunia.
Efek bedak terhadap kesehatan manusia menjadi perhatian karena banyak komponen
kimia yang terkandung di dalamnya. Review ini merupakan upaya untuk menyajikan
penelitian-penelitian yang relevan dalam bidang ini dan untuk menyimpulkan update
terkini mengenai topik tersebut. Paparan bedak serbuk telah terbukti menjadi
penyebab perkembangan mesothelioma dan karsinoma paru pada wanita. Bubuk
kosmetik biasa dapat menempel pada partikel yang lebih besar yang akan mengendap
di saluran nafas atas dari sistem respirasi manusia. Alveolar adalah regio kedua yang
paling sering terpapar dari sistem respirasi. Tingkat deposisi di area trakeobronkial
yang paling rendah. Bedak serbuk kosmetik, yang digunakan secara rutin oleh wanita
di seluruh dunia, dapat menyebabkan efek yang merugikan pada berbagai sistem
organ di dalam tubuh manusia. Kesadaran konsumen akan efek-efek berbahaya
tersebut pengguna mungkin bermanfaat untuk mengurangi penggunaannya hingga
batas tertentu.

Kata kunci: Pleurodesis, penyakit paru, Bedak serbuk.

Pendahuluan

Bedak tergolong ke dalam kelompok mineral umum yang berlapis silika yang
tersedia di alam dan tersusun dari kristal hisdorus magnesium silika. Bedak dalam
bentuk kombinasi dengan magnesit tersedia di seluruh dunia. Bedak murni saja juga
memungkinkan untuk ditemukan. Manfaat komersial didapatkan setelah melewati
proses penyortiran, yang mana kristal-kristal bedak digiling atau dimikronisasi
menjadi bubuk-bubuk yang halus. Struktur bedak adalah lembut, secara kimiawi tidak
aktif dan tampilan umum berwarna putih cerah. Warnanya dapat diubah dengan
pewarnaan besi atau melalui proses impurity menggunakan mineral-mineral lainnya.
Secara spesifik badak tidak dianggap berbahaya dan diklasifikasikan sebagai debu
iritan dalam bentuk bubuk.[1]

Dua jenis bedak, industri dan kosmetik, digunakan pada kertas, plastik-plastik, karet,
cat, dan pekerjaan manufaktur kosmetik.[2,3] Selain itu, zat ini telah terbukti efektif
untuk digunakan melalui tabung torakostomi. Termasuk di dalamnya bedak kosmetik
dan iodopovidone. Keduanya dianggap aman digunakan.[4] Bedak kosmetik dikemas
dalam bentuk bedak padat atau bedak serbuk, yang digunakan untuk riasan, dan
mengandung logam-logam berat seperti Cd, Co, Pb, Cu, dan Cr. Sebuah penelitian
terhadap tiga puluh merek bedak serbuk menunjukkan bahwa di dalamnya
terkandung logam-logam dalam batas aman, tetapi penggunaan bedak serbuk yang
berlebihan mempengaruhi kesehatan konsumen.[5] Beberapa penelitian telah
menunjukkan bahwa tingkat paparan bedak kosmetik jauh lebih rendah daripada
bedak-bedak di pabrik dan tambang.[3] Pengawet dan pewangi ditambahkan pada
produk kosmetik untuk menambah aroma dan penyajian yang menarik bagi
pelanggan. Bubuk-bubuk kosmetik memiliki kualitas antimikrobiologis yang buruk.
Bubuk-bubuk kosmetik tersebut dapat menjadi sumber mikroorganisme untuk
tumbuh dan cenderung lebih terkontaminasi oleh jamur dibandingkan oleh bakteri.
Beberapa bahan senyawa kimia ditambahkan untuk menghindari pertumbuhan
mikroba. Namun, mikroorganisme dapat menyebabkan kerusakan atau perubahan
kimiawi dari produk kosmetik tersebut.[5-8] Beberapa komponen dalam kosmetik
dapat memasuki kulit dan menyebabkan efek-efek sistemik.[9]

Pada tahun 2005, telah dilakukan penelitian terhadap beberapa kosmetik wajah yang
tersedia di Nigeria dan menunjukkan bahwa penggunaan kosmetik secara rutin dapat
menyebabkan peningkatan jumlah jejak logam pada tubuh manusia melebihi batas
keamanan, terutama apda sistem organ penglihatan.[10,11] Pada tahun 2012, kasus
pertama endobronkitis berat akibat penggunaaan bedak serbuk dilaporkan pada pasien
wanita.[12]

Sebuah penelitian pada tikus dilakukan oleh Shim et al. mengenai bedak, yang
melibatkan tikus Sprague - Dawley jantan maupun betina melalui paparan toksik
selama 4 minggu berulang melalui rute inhalasi ke seluruh tubuh. Tikus diberi bedak
uji (inhalasi) dengan konsentrasi yang berbeda seperti 0, 5, 50, dan 100 mg / m3
selama 6 jam / hari, selama 5 hari dalam seminggu, selama 4 minggu. Penelitian
tersebut melaporkan tidak ada adverse events atau kematian tikus yang terpapar
bedak. Penurunan pada glukosa terlihat pada tikus jantan yang terpapar bedak hingga
50 dan 100 mg / m3. Selanjutnya pergerakan makrofag pada dinding alveoli maupun
ruang yang berdekatan dengan bronkiolus terminal dan bronkiolus respiratorik dapat
diamati dalam analisis histopatologi. Superoksida dismutase 2, sebuah tanda genetik
khas dari kerusakan oksidatif, muncul pada tikus jantan dan betina yang terpapar
bedak 100 mg / m3. Mereka menyimpulkan bahwa agregasi makrofag dipicu oleh
inhalasi bedak. Faktanya, kerusakan pada paru dapat dikaitkan dengan stres oksidatif.
[13]

Bedak dan Penyakit Paru

Bedak menyebabkan empat jenis penyakit paru; tiga diantaranya terkait aspirasi
(talcosilicosis, talcoasbestosis, dan talcosis) dan satu akibat pemberian bedak secara
intravena. Jenis yang terakhir disebutkan terjadi pada pemakai narkoba yang
menyuntikkan obat yang seharusnya dikonsumsi melalui oral. Tanda talcosis paru
dilihat dari computed tomography (CT) resolusi tinggi yang menunjukkan nodul-
nodul sentrilobular kecil yang terkait dengan massa konglomerat heterogen. Temuan
ini terdiri dari area amorf yang memiliki kepadatan tinggi, dengan atau tanpa disertai
emfisema panlobular di lobus bawah. Penelitian-penelitian histopatologi dalam
sebuah laporan kasus menunjukkan adanya birefringent, partikel-partikel bedak
berbentuk jarum di dalam sel-sel raksasa dengan area-area fibrosis paru terkait
penggunaan polarized light pada talc pneumokoniosis. Penulis menyimpulkan bahwa
CT berperan penting dalam diagnosis talcosis paru, yang mana terlihat seperti
gambaran seperti yang disebutkan sebelumnya.[14] Jika pola seperti ini terlihat pada
pasien yang memiliki riwayat kontak dengan bedak atau pengguna obat-obatan
terlarang, maka sangat erat kecurigaan pada talcosis paru seperti yang ditunjukkan
pada Gambar 1a dan b.[2]

Gambar 1: (a dan b) dense consolidation setinggi bronkus utama, dengan dilatasi

bronkus, perubahan emfisematous pericatricial (panah), ground-glass opacities,
dan penebalan septal interlobular (kepala panah) pada lobus atas kedua paru
yang terlihat oleh CT-Scan axial thic section (ketebalan section 1,5 mm) pada
seorang pasien yang bekerja selama 8 tahun dalam prosessing magnesium
silikat.

Patofisiologi

Patofisiologi talcosis mungkin mirip dengan patofisiologi sarkoidosis. Talc

granulomatosis secara klasik dikaitkan dengan konsentrasi antikolinesterase serum
yang tinggi dan sejumlah besar limfosit pada apusan bronchoalveolar. Penderita
sarcoidosis harus dianamnesis secara komprehensif mengenai paparan debu organik
ataupun anorganik yang dialaminya. Kortikosteroid sebagai modalitas pengobatan
mengurangi gejala dan meningkatkan fungsi paru, meskipun kemungkinan
kekambuhan terjadi setelah pengobatan selesai.
Kemiripan substansial dalam hal tanda dan gejala klinis serta imaging dan parameter-
parameter laboratorium di antara pasien-pasien dengan fibrosis paru membutuhkan
anamnesis yang rinci sebagai kunci untuk mengidentifikasi penyakit.

Shinno dkk. mempresentasikan sebuah case series menganai acute respiratory

distress syndrome (ARDS) setelah pleurodesis menggunakan bedak berukuran
makropartikel (2018). Mereka menemukan bahwa usia lanjut dan adanya perubahan
interstisial di paru-paru seperti yang ditunjukkan dalam CT thoraks sepertinya
merupakan risiko munculnya ARDS posttalk pleurodesis.[15,16] Beberapa penelitian
menunjukkan outcome talc pleurodesis yang sukses pada pasien efusi pleura ganas
masif menggunakan pleurodesis dengan thoracoccopic talc insufflation (memasukkan
bubuk ke dalam saluran napas melalui torakoskopi) atau dengan talc slurry
instillation (pemberian cairan campuran serbuk tetes demi tetes) dengan tingkat
keberhasilan yang sama.[17] Keberhasilan bergantung pada beberapa faktor termasuk
jenis kelamin wanita, Karnofsky Performance Score > 70, pH cairan pleura ≥7.34,
adenosine deaminase ≥18 IU / l, dan kolesterol cairan pleura ≤82 mg / dl.[18,19]

Sebuah penelitian yang dilakukan di Jerman menunjukkan hubungan positif antara

asbes, bedak, karsinoma paru, karsinoma laring, dan karsinoma lambung pada pekerja
karet. Kematian karena penyakit paru noncarcinomatosa juga meningkat bila terpapar
bedak.[17,18] Kontak jangka panjang dengan bedak serbuk dapat menyebabkan
bronkitis kronis dan pneumosistis.[20-22]

Paparan bedak serbuk telah terbukti sebagai penyebab perkembangan mesotelioma

dan karsinoma paru pada wanita[23,24] Paparan bedak bebas silika dan asbes sebagai
penyebab pneumokoniosis maupun gangguan pernapasan kronis. Terdapat banyak
penelitian tentang efek bedak pada sistem organ berbeda [Tabel 1]. Penambang dan
pekerja pabrik yang terpapar bedak bebas asbes dan silika dapat berkembang menjadi
efek-efek obstruktif paru.[25]
Tabel 1: Beberapa penelitia yang
membahas tentang n efek- bedak
serbuk pada kesehatan efek
Peneliti Efek-efek bedak pada kesehatan
Franc C[15] Talkosis paru
Shinno et al.[16] ARDS, ALI
Yildirim et al.[19] Bronkitis Kronis
Straif et al.[20] Pneumosistis, pneumokoniosis
Wild et al.[21] Kanker paru dan kanker laring
Hildick-Smith[32]
Wegman et al.[25] Kanker Ovarium
Karageorgi et al.[33] Risiko kanker endometrium
Kuzniar et al.[31] Hipoksemia berat
Genofre et al.[8] Respon inflamatorik
Lange et al.[24] Kerusakan fungsi paru dan pelebaran
pleura
ARDS: Acute respiratory distress syndrome, ALI: Acute lung Injury

Penggunaan bedak yang lebih aman

Bedak digunakan dalam pengobatan pneumotoraks spontan idiopatik meskipun dapat

menyebabkan gangguan restriktif ringan pada fungsi paru dan penebalan pleura yang
terlihat pada rontgen thoraks.[24]

Terdapat artikel-artikel dalam literatur yang menyimpulkan bahwa bedak tidak

berbahaya. Gen-gen GSTM1 dan GSTT1 pada wanita dapat bervariasi dan variasi ini
diketahui mempengaruhi pada hubungan antara penggunaan bedak genital dan risiko
kanker ovarium.[26] Sebuah analisis dari sampel bedak kosmetik authentic historical
Italian oleh Ilgren et al. melalui selected area electron dissraction yang
dikombinasikan dengan energy dispersive X-ray analysis menemukan bahwa bedak
kosmetik Pinerolo Italian tidak menyebabkan risiko kanker dikarenakan
kemurniannya.[27,28] Demikian pula, pekerja-pekerja bedak Prancis dan Austria yang
diperiksa untuk mengetahui efek dari debu bedak pada sistem pernafasan
menggunakan tes fungsi paru dan X-ray thoraks, tetapi tidak menunjukkan bukti
apapun mengenai efek merugikan paparan bedak tersebut.[29]

Bedak serbuk kosmetik biasa dapat menempel pada partikel yang lebih besar yang
akan tersimpan pada saluran nafas bagian atas dari sistem pernapasan manusia.
Alveolar adalah regio terbesar kedua yang paling terpapar dari sistem pernapasan.
Tingkat deposisi terendah yaitu pada regio trakeobronkial. Kedua zat tersebut, bedak
dan partikel yang lebih besar, akan terus bercampur dan partikel-partikel bedak yang
kecil menyebabkan respon inflamasi. Kedua jenis partikel tersebut tampak
terendapkan di paru-paru, limpa, hati, dan ginjal pada penelitian-penelitian pada
hewan coba.[30] Medical thoracocopic talc pleurodesis merupakan analgesik dan
terapi yang bermanfaat untuk mengobati efusi pleura ganas.[31] Penggunaan bedak
serbuk di daerah perineum terbukti meningkatkan peluang kanker endometrium.
Kejadian ini lebih sering terjadi pada wanita pascamenopause.[33]

Kesimpulan

Bedak serbuk kosmetik, digunakan secara rutin oleh wanita di seluruh dunia, dapat
menyebabkan efek merugikan pada sistem organ yang berbeda dari tubuh manusia.
Kesadaran akan efek berbahaya bagi konsumen akan bermanfaat untuk mengurangi
penggunaan hingga batas tertentu. Penelitian lebih lanjut diperlukan untuk
mendapatkan lebih banyak bukti tentang pengaruhnya terhadap sistem pernafasan.