Urgent attention needed towards street-performing children exposed to toxic metallic paint in Pakistan

Sir,

Around the globe, children performing on streets have been involved in performances making themselves visually attractive to earn a living; which frequently involves painting their body and face. With limited regulatory oversight children are exposed to these hazardous chemicals through these informal economic activities. This issue has been alarmingly escalating in South Asia, particularly in Pakistan. Additionally, in urban Karachi this sight is very common to witness children in gold or silver metallic paints at traffic signals and tourist hotspots like Khayaban-Ittehad and Seaview; that too in this scorching heat to earn a minimal wage. These metallic paints; often inexpensive and unregulated contain harmful chemicals like lead, aluminum and other heavy metals posing a serious health concern.¹

Children are vulnerable to the toxicants due to number of interconnected reasons; increased ratio of surface area to body weight leading to increased dermal absorption. Also, their immature and rapidly developing organs makes them more vulnerable.^2,3 Moreover, a small amount of lead exposure maybe associated with learning problems, decreased cognition and behavioral difficulties.⁴ The increase in temperature exacerbates the toxicity of the toxicants and inhalation of particles elevates the risk.⁵ Aluminum used as a pigment base in paints has been associated with dermatitis, and neurotoxicity with the chronic exposure.⁶

Despite World Health Organization (WHO) alarming about the toxicity of the lead, or the bans on the use of lead in household paints and the measures taken for it lead-based paints are still produced and used particularly in low middle income countries (LMICs).^4,7 Unfortunately, Pakistan was not able to fully implement it; with lead content decreased yet still greater than the cutoff value.⁷ While there has been some progress made in paints, there is still lack of attention to cosmetic and body paints, particularly those worn by the street kids; who belong to the underprivileged groups of the country. These little ones often perform with little healthcare access or adult supervision making them susceptible to toxic exposure. The main objective of writing this is to draw attention to this major public health risk concern this vulnerable population is facing particularly in Karachi. There should be legislation to ban these metallic paints toxic to the skin and body, especially in children. This should be paired with the awareness to the general public to ensure the impact is made. Also, cross-sectional studies must be conducted to assess the blood lead and aluminium levels in these children, further evaluating the neurobehavioural and dermatological symptoms.

The immediate action is required as these kids are not doing it by choice. They are victims of poverty affected background and systemic neglect. Failing to act now may result in preventable public health crisis with long term consequences.

REFERENCES

1. 1. Salles FJ, Paniz FP, Batista BL, Nardocci AC, Olympio KPK. Potentially Toxic Elements in Costume Cosmetics Used by Children and Adults Are Associated with Cancer Risk. Int J Environ Res Public Health. 2022;20(1):531.
2. 2. Children’s unique vulnerabilities to environmental hazards. Available at: https://ceh.unicef.org/sites/default/files/2025-02/250210_Fragile_Beginnings_Childhood.pdf. Accessed on 15 June 2025.
3. 3. Carroquino MJ, Posada M, Landrigan PJ. Environmental Toxicology: Children at Risk. Environ Toxicol. 2012;239-91.
4. 4. World Health Organization. Lead poisoning. 2024. Available at: https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health#:~:text=There%20is%20no%20known%20safe%20learning%20problems%20. Accessed on 15 June 2025.
5. 5. Gordon CJ, Johnstone AFM, Aydin C. Thermal stress and toxicity. Compr Physiol. 2014;4(3):995-1016.
6. 6. Murthy AB, Palaniappan V, Karthikeyan K. Aluminium in dermatology – Inside story of an innocuous metal. Indian J Dermatol Venereol Leprol. 2024;90:755-62.
7. 7. Siddiqui DEA, Coulter L, Loudon C, Fatmi Z. ‘The brighter the worse’: Lead content of commercially available solvent-based paints intended for residential use in Pakistan. F1000Research. 2023;12:166.