The Florence Statement on Triclosan and Triclocarban.

The Florence Statement on Triclosan and Triclocarban documents a consensus of more than 200 scientists and medical professionals on the hazards of and lack of demonstrated benefit from common uses of triclosan and triclocarban. These chemicals may be used in thousands of personal care and consumer products as well as in building materials. Based on extensive peer-reviewed research, this statement concludes that triclosan and triclocarban are environmentally persistent endocrine disruptors that bioaccumulate in and are toxic to aquatic and other organisms. Evidence of other hazards to humans and ecosystems from triclosan and triclocarban is presented along with recommendations intended to prevent future harm from triclosan, triclocarban, and antimicrobial substances with similar properties and effects. Because antimicrobials can have unintended adverse health and environmental impacts, they should only be used when they provide an evidence-based health benefit. Greater transparency is needed in product formulations, and before an antimicrobial is incorporated into a product, the long-term health and ecological impacts should be evaluated. https://doi.org/10.1289/EHP1788.

Introduction

In September 2016, the U.S. Food and Drug Administration (FDA) banned nineteen antimicrobial ingredients, including triclosan and triclocarban, in over-the-counter consumer antiseptic wash products based on insufficient evidence demonstrating their safety for long-term daily use and that they reduce the spread of illness and infection. Many of those 19 chemicals have been in widespread use for decades, and many are still allowed in a number of other over-the-counter personal care products as well as in consumer and building products. The FDA first indicated in a 1974 Tentative Final Monograph that there was insufficient evidence to show that triclosan was effective and safe for long-term use (Halden 2014). The FDA’s decades-long path to issuing a final rule, and the narrow scope of the September 2016 Final Rule (FDA 2016), indicate that existing regulatory practices are not sufficient to protect human and ecosystem health from adverse impacts of antimicrobial chemicals. Scientists from both academia and nonprofit organizations coauthored The Florence Statement in 2016 to share current scientific research on two widely used antimicrobial chemicals and to motivate broader consideration of the long-term impacts of antimicrobial use (see Appendix I). The Statement was introduced at DIOXIN 2016, the 36th International Symposium on Halogenated Persistent Organic Pollutants in Florence, Italy, and has been signed by more than 200 international scientists and medical professionals (see Appendix II).

The Florence Statement on Triclosan and Triclocarban

As scientists, medical doctors, and public health professionals, we are concerned about the continued widespread use of the chlorinated antimicrobials triclosan and triclocarban for the following reasons:

Triclosan and triclocarban are used as antimicrobials, a class of chemicals present in products including soaps, toothpastes, detergents, clothing, toys, carpets, plastics, and paints. In personal care products like hand soap, there is no evidence that use of triclosan or triclocarban improves consumer or patient health or prevents disease.

Triclosan and triclocarban used in consumer products end up in the environment and have been detected in a wide variety of matrices worldwide.

Triclosan and triclocarban persist in the environment and are a source of toxic and carcinogenic compounds including dioxins, chloroform, and chlorinated anilines.

Triclosan, triclocarban, and their transformation products and byproducts bioaccumulate in aquatic plants and animals, and triclosan partitions into human blood and breast milk.

Triclosan and triclocarban have detrimental effects on aquatic organisms.

Humans are exposed to triclosan and triclocarban through direct contact with personal care products and from other sources including food, drinking water, and dust. Triclosan has been detected in the urine of a majority of humans tested.

Triclosan and triclocarban are endocrine disruptors and are associated with reproductive and developmental impacts in animal and in vitro studies. Potential implications for human reproduction and development are of concern and merit further study.

Human epidemiology and animal studies suggest triclosan exposure can increase sensitivity to allergens.

Overuse of triclosan may contribute to antibiotic/antimicrobial resistance and may modify the microbiome.

A number of authorities, including the FDA, have restricted the use of triclosan and triclocarban in certain types of soaps. These and other antimicrobial chemicals are generally not restricted from use in other products.

We therefore call on the international community to limit the production and use of triclosan and triclocarban and to question the use of other antimicrobials. We urge scientists, governments, chemical and product manufacturers, purchasing organizations, retailers, and consumers to take the actions recommended below.

Recommendations

Avoid the use of triclosan, triclocarban, and other antimicrobial chemicals except where they provide an evidence-based health benefit (e.g., physician-prescribed toothpaste for treating gum disease) and there is adequate evidence demonstrating they are safe.

Where antimicrobials are necessary, use safer alternatives that are not persistent and pose no risk to humans or ecosystems.

Label all products containing triclosan, triclocarban, and other antimicrobials, even in cases where no health claims are made.

Evaluate the safety of antimicrobials and their transformation products throughout the entire product life cycle, including manufacture, long-term use, disposal, and environmental release.