- Discussion
- 10.1002/rcr2.70368
Letter to the Editor: ‘Asbestosis Requiring Lung Transplantation in a Retired Hairdresser: An Occupational Exposure to Comb Through’
- Oct 01, 2025
- Respirology Case Reports
- Evan Anderson + 6 more +6
We appreciate the opportunity to comment on the case report ‘Asbestosis Requiring Lung Transplantation in a Retired Hairdresser: An Occupational Exposure to Comb Through’ authored by Bu et al. [1] The authors report a case that they concluded was asbestosis in a retired hairdresser and speculate the source of asbestos exposure was the use of hair dryers containing asbestos, along with the possible contamination of cosmetic talc with asbestos. Asbestosis in hairdresser cohorts would be a novel finding, but as we discuss below, several lines of reasoning from the scientific literature raise serious questions as to the conclusions in this case report. Alternative explanations should be further pursued. Asbestosis is a marker of relatively high asbestos exposure. Clinical findings of asbestosis have been reported at 25 fibre-years/cm3 (f-yrs/cc) or higher [2], with exposures at the current Occupational Safety and Health Administration permissible exposure limit and American Conference of Governmental Industrial Hygienists threshold limit value of 0.1 f/cc for a career (i.e., 4 or 4.5 f-yrs/cc) protective of asbestosis risk. Hair dryers may have historically contained a non-friable chrysotile asbestos component. Exposures related to the use of hair dryers show relatively low task-based exposure; the authors reference a 1979 report from the National Institute for Occupational Safety and Health that showed ‘structures’ between zero and 0.11 structures/cc (s/cc). Asbestos exposures reported in s/cc are not a reliable means of ascertaining asbestos-related disease risk, and ‘fibres’ longer than 5 μm (μm) are a minimum cutoff in asbestos regulatory definitions. Nonetheless, using conservative assumptions, cumulative airborne exposures for a career hairdresser would be far below 4 f-yrs/cc. The authors presented an erroneous calculation of cumulative yearly exposure of ‘25,100 fibres per cubic centimetre each year’, when the actual reference in Roggli et al. is in the range of ‘25 to 100 fibres/mL-years’ (e.g., f-yrs/cc) [2]. Additionally, it is not appropriate to assume that s/cc is directly comparable to f/cc. When placed in the correct context, the authors' suggestion that the use of hair dryers poses a risk of asbestosis is not supported. Additionally, the possible presence of asbestos in cosmetic talc since the 1970s has been demonstrated to result in diminishingly low exposures [3], which is confirmed by the lack of mesothelioma risk in hairdressers [4]. The literature simply does not support any likelihood of asbestosis risk from the use of cosmetic talc. The authors reportedly found asbestos bodies in the lung. Further information would elucidate this finding, including whether the asbestos body count is greater than background levels and the fibre type identified. For example, an asbestos body composed of a commercial amphibole asbestos would rule out the asbestos exposures reported and discussed above, and may suggest other unidentified exposures if the asbestosis diagnosis is validated. Case reports are appropriate for generating hypotheses but are insufficient for drawing the sweeping conclusions that the authors are attempting to make. Readers are cautioned against drawing any conclusive inferences with the available information in the etiological determination of a purported asbestosis case. Evan Anderson drafted the letter. Shannon Meyler reviewed it critically for important intellectual content. Alexa Gallagher reviewed it critically for important intellectual content. Tina Cardona reviewed it critically for important intellectual content. Benjamin Ellis reviewed it critically for important intellectual content. Jennifer Ellis final approval of the version to be published. Michael Holton final approval of the version to be published. The authors received no specific funding for this work. Some of the authors of this letter (EA, JE, MH) have testified on behalf of defendants in asbestos and talcum powder litigation matters. No law firm was involved in the writing of this letter, and it was not written for purposes of litigation. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
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