The pharmacy in any corner drug store brims with carefully formulated, tested, and regulated drugs. But aisles packed with personal care products—shampoos, makeup, lotions—are a different story.

For the most part, these products aren’t regulated at all. The gels, creams, and concoctions we slather on our skin and massage into our heads on a daily basis clear no regulatory hurdles before strolling into neighborhood stores and medicine cabinets. The Food and Drug Administration only looks into these products when people voluntarily report problems. And people hardly ever report problems to the FDA—even when there are big ones. In a research letter this week in JAMA Internal Medicine, a trio of researchers argue that something has got to change.

A major motivation for their argument is the recent scandal involving WEN by Chaz Dean hair care products. (You’ve likely seen the celebrity-studded infomercials.) The FDA opened an investigation into WEN in 2014 after the agency received complaints that the brand’s Cleansing Conditioners were irritating scalps and causing hair to fall out. A whopping 127 complaints rolled in—that’s a lot for the FDA. In 2007, for instance, the agency received fewer than 200 complaints total, for all personal care products sold in the country.

After the FDA started asking WEN questions, it came out that the company was sitting on another 21,000 complaints.

Last year, amid the investigation, the agency tallied 1,386 more complaints of hair loss and scalp irritation. And WEN settled a class-action lawsuit for $26 million. It's now in the process of compensating customers. When the settlement was announced, WEN released a statement saying that its products were safe. The statement said:

We continue to provide our hundreds of thousands of customers with the Wen by Chaz Dean products that they know and love. Since the process of litigation is time consuming and costly, we made a business decision to pursue a settlement and put this behind us so that we can focus on delivering quality products.

The researchers, writing this week in JAMA Internal Medicine, say the situation shouldn’t have gone this far. Michael Kwa, Leah J. Welty, and Shuai Xu of Northwestern University say that researchers and regulators need better surveillance, monitoring, and coordinated data collection to protect consumers.

“Better cosmetic surveillance is needed given their ubiquity and lack of a premarket approval pathway,” they write. “Unlike devices, pharmaceuticals, and dietary supplements, cosmetic manufacturers have no legal obligation to forward adverse events to the FDA.”

As a start, the researchers sifted through the FDA’s repository of consumer complaints about personal care products that it has gotten. It’s called the Center for Food Safety and Applied Nutrition’s Adverse Event Reporting System (CFSAN). The agency made it public in 2016 in the wake of WEN’s complaints.

CFSAN contains 5,144 complaints made between 2004 and 2016. The researchers sorted them by time, type of product, and the severity of complaint. The FDA received, on average 396 cosmetic-related complaints per year, the researchers found. But there was a 78 percent increase in 2015 and a 300 percent increase in 2016 compared with the mean across the entire time frame—those increases were mostly due to WEN.

Overall, the three most common types of products that spurred complaints were hair care products, skin care products, and tattoos. The types of products that were most likely to be associated with serious health problems (defined as serious injury, disability, congenital anomaly, or death) were baby products, unclassified products, personal cleanliness products, hair care, and hair coloring products.

“CFSAN reflects only a small proportion of all events,” the researchers emphasize. But “the data suggest that consumers attribute a significant proportion of serious health outcomes to cosmetics.” Solving the problem will be difficult, the researchers note. But they point to promising proposed bills such as the Personal Care Products Safety Act (PCPSA), introduced by Senator Dianne Feinstein (D-Calif.). The bill would give the FDA the power to recall personal care products, do yearly safety reviews, and make complaint reporting mandatory for manufacturers.

JAMA Internal Medicine, 2017. DOI: 10.1001/jamainternmed.2017.2762 (About DOIs).