Is lipstick associated with the development of systemic lupus erythematosus (SLE)?

Jun Wang, Ashley B. Kay, Jeremiah Fletcher, Margaret K. Formica, Timothy E. McAlindon

Lipstick use has been hypothesized to be a risk factor of developing systemic lupus erythematosus (SLE). The objective of this study was to investigate the association between lipstick use and risk of SLE. We performed an Internet-based case-control study of SLE with Google users searching on medical key terms as the source population. Cases were diagnosed within 5 years and met > or =4 ACR criteria for SLE by medical record review. Controls were matched to cases on age, gender, race, ethnicity, region of residence, reference year, education, and income using propensity score. Demographic characteristics and lifestyle factors were collected using an online questionnaire. Conditional logistic regression models were used for the analyses with smoking, alcohol consumption, permanent hair dye use, and chemical hair straightener use adjusted. The analysis included 124 cases and 248 matched controls of whom 96% were females and 81% were whites. The median of disease duration was 2 years (range 0-4 years). Using lipstick at least 3 days/week was significantly associated with increased risk of SLE (adjusted OR = 1.71, 95%CI = 1.04-2.82). There was a trend of greater risk with earlier age of initiation of lipstick use (<16 years vs. never use; OR = 1.95, 95%CI = 1.01-3.76, p trend = 0.02) and with increased frequency of use (7 days/week vs. never use; OR = 1.75, 95%CI = 0.89-3.44, p trend = 0.07). Biologic effects of chemicals present in lipsticks absorbed across the buccal mucosa and confounding from unmeasured lifestyle factors could be the explanation of this association. Epidemiologic studies of SLE should include this exposure in exploring its environmental triggers.