The dangers of using black-market skin-lightening creams are highlighted in a Clinical Picture in this week’s edition of The Lancet. Drs Tricia Tan and Tony Goldstone, Endocrine Unit, Department of Investigative Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK, were part of the team who helped treat the patient concerned, and co-authored the Clinical Picture.
The woman, who was 28-years-old, had gained 12.7kg in three years and had also been trying to conceive for 18 months – without success- despite having regular periods. She reported having stripes on her arms, back, abdomen and legs, and bruising easily – she also had recurrent thrush. Her history was otherwise unremarkable – in particular, she denied taking any illicit or prescribed drugs.
On examination, doctors noted central obesity (BMI > 36.6 kg/m2 – BMI of over 30 is considered obese), a fat pad between the shoulder blades, and a round face. She had pigmented stretch marks all over her body and thin, bruised skin, as well as mild hair growth on her back and face. She also had muscle weakness
Doctors provisionally diagnosed Cushing’s syndrome based on these findings. Cushing’s syndrome is a condition that results from excess levels of steroid hormones in the blood that are usually produced by the adrenal glands, caused either directly by malfunctioning adrenal glands or a malfunctioning pituitary gland sending too high a signal to the adrenal glands, with the same result. However, blood tests showed extremely low concentrations of the steroid hormone cortisol and the hormone signal from the pituitary – corticotropin.
The medical team again asked the patient about drugs, and the patient then admitted she had used a skin-lightening cream for seven years. This cream had not been bought from a pharmacy, but from a local shop unauthorised to stock it. Further inquiries revealed the cream to be the potent steroid clobetasol. The patient was using around 60g (two tubes) per week.
The authors conclude: “Patients are often reluctant to admit that they have used skin-lightening creams – especially if these are supplied illegally. Similarly, doctors can be unaware of the need to inquire. But the market is worth millions of pounds a year, in the UK alone. Creams can contain toxic substances, such as steroids and hydroxyquinone – and patients are typically unaware of the risks.”
For Dr Tricia Tan and Dr Tony Goldstone, please contact Imperial College Healthcare NHS Trust Press Office (office hours), Cymbeline Moore, T) +44 (0) 208 383 3002/5 mobile: +44 (0) 7825 062049 E) cymbeline.moore@imperial.nhs.uk ; t.tan@imperial.ac.uk; tony.goldstone@csc.mrc.ac.uk
http://multimedia.thelancet.com/pdf/press/Clinicalpicture.pdf
Journal
The Lancet