Coeliacs are required to follow a gluten-free food diet – but do they need to follow a gluten-free skincare ‘diet’ too? Over fifty years after the blame for coeliac disease was pinned on gluten, this question remains unanswered. In the absence of research on the issue, the coeliac consumer remains reliant on the informed opinion of experts and coeliac societies.

However, anecdotal reports from coeliacs who’ve used gluten-containing cosmetics and reacted adversely are commonplace.

“Conventional medical wisdom is that there is no risk to coeliacs unless the patient gets the product into their mouth or an open sore,” says Dr Ron Hoggan, editor of the Journal of Gluten Sensitivity. “Yet my daughter tried a cream that contained oats and developed a rash that stayed until she stopped using it.”

This is typical of what many coeliacs experience, as countless online discussions will testify: some react adversely to cosmetics they assumed were safe, only to find on closer investigation they contained derivatives of gluten grains.

Oats and wheat

Although barley (hordeum vulgare) is occasionally used in skincare, and rye (secale cereale) is rare, the use of wheat and oat derivatives is widespread.

Oat (avena sativa) contains skin-soothing compounds, and its derivatives are found in bath soaks, and products for eczema and psoriasis. It also turns up in soap bars and as an exfoliating agent in face and body scrubs.

Wheat (triticum vulgare) is commonly found in many forms on labelling:

• ‘Wheatgerm oil’ – an emollient, rich in vitamin E. It’s found in moisturisers, anti-ageing products, body oils and lipsticks – such as those by Youngblood. ‘Tocopherol’ may indicate wheatgerm oil.

• ‘Wheat starch’ – a volumiser, found in make-up, including Green People’s mascara.

• ‘Hydrolyzed wheat starch’ – starch which has been broken down into simpler carbohydrate molecules, and used as a skin conditioner and to add viscosity, and is found mostly in haircare products (eg shampoo, hairspray, gels and dyes).

• ‘Wheat bran’ – “the broken coat material of grains of wheat”, as EWG’s Cosmetics Database describes it, is used as an exfoliating or bulking agent. Its ‘extracts’ or ‘lipids’ may be used in haircare products.

Amino Acids and HWP

Although the above 'wheat variations' may carry more or fewer traces of gluten, it is the gluten proteins that challenge the immune system.

• ‘Wheat amino acids’ – formed by hydrolysis and complete breakdown of wheat protein into its constituent amino acids. Typically, they are found in hair products (eg John Masters Organics), as their small size means they penetrate hair follicles easily. Because they attract moisture, they improve flexibility, manageability and condition. As simple molecules, pure amino acids cannot trigger immune reactions.

• ‘Hydrolyzed wheat protein’ (HWP) – the major wheat-derived ingredient encountered in cosmetics, although it can appear under several guises / synonyms, such as ‘wheat hydrolysate’, ‘enzyme-modified gluten’, ‘wheat peptides’ and other variations.
HWP conditions the skin and hair, and is used in shampoos, conditioners, anti-ageing products, face powders and styling gels. It is valuable in hair-repairing products as the peptides it contains bond effectively with chemical-damaged hair follicles. It gives the illusion of thicker hair, and tackles split ends.

HWP is formed from hydrolysis of proteins to peptides, which structurally fall between complex proteins and simple amino acids.

Interestingly, there is evidence that HWP can trigger IgE-mediated allergies, because hydrolysing exposes new parts of wheat protein’s molecules, normally ‘buried’ inside their complex structures, which trigger the reactions – even when there is no reaction to whole or ‘underleased’ protein.

A 2006 French report described cases of nine women reacting in this way, six of whom also reacted to HWP in processed food products. None reacted to ordinary wheat products in the diet (ie bread, pastas).

A further report described cases of HWP-induced nettle rash, and speculated that dermatological sensitisation to HWP could eventually progress to dietary sensitisation, and even anaphylaxis – see this report.

What does this mean for coeliacs?

Perhaps nothing. In fact, a study has suggested that dietary hydrolyzed wheat is actually tolerated by coeliacs. And besides, the reactions to HWP described in the French reports were IgE allergies – distinct from autoimmune diseases such as coeliac.

Where might gluten lurk?

Without industry standards or gluten-specific labelling regulations, the consumer is rarely assured that a product, or any wheat- or oat-derived ingredient it contains, is gluten free.

The word ‘gluten’ is unlikely to appear on a label at all, and when it does it can be a red herring: the expression ‘corn gluten’ (or ‘zea mays gluten’) is seen on American products, such as NYC’s face powder, stocked in Superdrug – a potential ‘false alarm’ to UK coeliacs unused to seeing coeliac-safe corn protein referred to in this way.

Occasionally, gluten derivatives may be present when no grain is mentioned: for example, ‘amino peptide complex’ and ‘phytophingosine extract’ are barley derived, and ‘beta glucan’ oat derived, but this may not be declared.

These problems were highlighted in October 2011 with the presentation of a study from researchers at George Washington University. Drs Marie Borum and Pia Prakash looked at the availability of gluten-related information on products by the top ten US cosmetic firms, and found only two offered detailed ingredient information at their websites. Independent websites carried information for five, and no information could be found for four. The researchers called this ‘alarming’, observing that while smaller companies may make a point of their gluten-free status, not one of the ten offered any declared gluten-free options.

In Europe, change may be afoot. The German Coeliac Society (DZG) have set standards for gluten-free cosmetics: any not containing gluten-grain derivatives are passed, but products using ingredients sourced from gluten grains must be submitted for chemical analysis, and can only be deemed gluten-free if meeting the food equivalent threshold (ie 20ppm of gluten maximum). Dr Hauschka recently applied for evalution, and all but a handful of their products received recognised gluten-free status.

Can ‘cosmetic gluten’ enter the body?

Currently, it is impossible to know how much gluten may be in an ingredient or product, and although we cannot rule out trace gluten in ingredients that should be free of it, such as wheatgerm oil or hydrolyzed wheat starch, the likeliest source of more appreciable levels in skincare seems to be via unfragmented remnants in HWP. Can this gluten cause a problem when applied to skin?

Dr Michel Lauriere, of the Institut National de la Recherche Agronomique in Grignon, France, who was involved in the study on the allergenicity of HWP, says the quantity of hydrolyzed proteins applied to skin through cosmetics are small, and the fraction of polypeptides crossing the skin barrier will also be small. He speculates ‘very sensitive’ patients may ‘experience some discomfort’ after repeated applications.

“The polypeptides crossing the skin probably don’t diffuse passively,” he says, pointing out that immune cells called dendritic cells in the skin’s tissues are likely to be involved. “It’s not known whether these cells, through T cells, can activate any immunological signal in the mucosa of the intestines of coeliacs. Only research could answer this.”

Cosmetic scientist Colin Sanders is also dubious: “Gluten is a big molecule that is not going to get through intact skin. It might manage to get through pores and cuts in the skin, but that is a very narrow gate … [and] it is only going to diffuse through to the bloodstream very slowly indeed. I would be surprised if there was much absorption even if you covered your skin in neat gluten.”

Curiously, ‘neat gluten’ appears rare in cosmetics. Unqualified expressions such as ‘wheat protein’ (or ‘triticum vulgare gluten’), suggesting gluten in an unprocessed and potentially riskier state, are infrequently found – although Paul Mitchell’s Lite Detangler, for example, includes it.

If not gluten … ?

We cannot rule out that gluten applied to the skin of coeliacs can cause symptoms by mechanisms unknown. But other possibilities to account for reactions appear more likely.

If you react to skincare products containing HWP, an IgE-mediated reaction, as described in Lauriere’s study, is possible. Coeliacs are just as likely as non-coeliacs to be prone to allergic reactions.

Psychological reasons are also a possibility. We know stress exacerbates symptoms of eczema, that there are psychological components to chronic urticaria, and that skin symptoms can be somatised. Think of blushing, and of itchiness when you think of itching. It’s not implausible that, say, feeling trepidation towards using a wheat-containing product could, in some individuals, manifest in a physical response.

The bottom line

Shampoos and shower gels can get into eyes and the mouth. Eye make-up is clearly applied to a sensitive area and stays in contact with it for hours. Creams and lotions are applied using hands, and then hands are used to handle food…

Hairspray, often containing wheat, can not only land on the absorbent parts of the face, but can diffuse into the immediate atmosphere, be inhaled, coughed up and swallowed, or land on surfaces and be picked up on fingers…

But lipsticks and balms are the biggest concern. “If you use a lipstick containing ingredients derived from gluten, it’s unlikely you’d swallow enough to cause a problem,” is the view of Coeliac UK’s head of diet Norma McGough, but the National Foundation for Celiac Awareness is more wary, and advises avoidance of such lipcare products.

Overall, then, although the threat may be low, there are various degrees of risk, eg:

• a cosmetic with a low-risk ingredient (eg wheatgerm oil) used on a low-risk part of the body (eg skin on torso, limbs);
• one with a medium-risk ingredient (eg wheat starch) on a medium-risk part (eg hands, face);
• one with a higher-risk ingredient (eg HWP) on a higher-risk part (eg lips, eyes).

Ultimately, where you draw the line remains a personal decision based on your sensitivity and experience. But if you’ve been using certain potentially gluten-containing cosmetics for some time, with no symptoms, and your specialists are happy with your blood tests – there is no clear need to look for alternatives.

Some basic precautions appear wise, though. Avoid applying products to broken or inflamed skin, and if you use a lot of lipcare, it’s perhaps advisable to stick to gluten-free ones.

For some coeliacs, none of the arguments will matter: for them, a gluten-free household is paramount, and on this basis they will choose absolute avoidance.

So here is a listing of manufacturers who have told us they have entirely gluten-free (GF) ranges (other ‘free from’ properties – WF (wheat free), DF (dairy free) and NF (nut free) – are also noted where appropriate). We hope to add to this on an ongoing basis.
Remember even firms who do not offer entirely ‘free from’ ranges will have individual products which do meet the criteria. If ever labelling is ambiguous or unclear, contact customer service departments or check websites.

Gluten/wheat-free cosmetic ranges

100% Organics – GF/WF/DF
Balaton Spa – GF/WF/DF/NF
Balm Balm – GF/WF/DF
CocoonU Organic range – GF/WF/DF/NF
Essential Care – GF/WF/DF/NF
HerbFarmacy – GF/WF/DF
MuLondon.com – GF/WF/DF/NF
Pai Skincare – GF/WF/DF
Queen Cosmetics – GF/WF/DF/NF
Raw Skin Food – GF/WF/DF/NF
Ruby Red Cosmetics – GF/WF/DF
Skin Blossom – GF/WF/DF
Witch Skincare – GF/WF/DF/NF

If you wish to contact Alex you can do so via his blog www.foodallergyandintolerance.blogspot.com

First published November 2011

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