A Clinical Picture described in the February 16, 2008 issue of The Lancet underlines the perils of using skin lightening creams sold on the black market. Dr. Tricia Tan and Dr. Tony Goldstone of the Endrocrine Unit in the Department of Investigative Medicine, Imperial College Healthcare NHS Trust, Hammersmith
Hospital, London, UK, were involved in the team that treated the patients and co-authored this piece.
The woman, at 28 years old, had gained 12.7 kg (28.0 lb) in the previous three years and had been attempting impregnation for 18 months unsuccessfully, despite a regular menstrual cycle. She also described stripes on her arms, back abdomen, and legs, in addition to sensitivity to bruising and recurrent thrush or yeast infection. Otherwise, her medical background was not remarkable, and she specifically denied the use of illegal or prescription drugs.
Doctors noted central obesity (a Body Mass Index (BMI) greater than 36.6 kg/m2, where a BMI that is greater than 30 is considered obese), a pad of fat between her shoulder blades, and round face. She had pigmented stretch marks on her body, as well as thin, bruised skin, and mild hair growth on her back and face, combined with muscle weakness.
Tentatively, a diagnosis of Cushing’s syndrome was proposed. Cushing’s syndrome results from excess levels of steroid hormones in the blood, generally coming from the adrenal glands, and is usually caused by a directly malfunctioning adrenal gland or an overactive signal from the pituitary gland to the adrenal glands with the same result. However, in this patient, blood concentrations of cortisol, a steroid hormone, and corticotropin, the signaling hormone from the pituitary, were very low.
A second inquiry was made to the patient regarding drugs, and the patient conceded to using a skin-lightening cream for up to seven years previous. The source of this cream was not a pharmacy but rather a local shop, which was not stocking it legally. Deeper investigation made it clear that the cream had clobetasol, a strong steroid, and that she had been using two tubes (approximately 60g) per week.
A conclusion was made regarding skin-lightening cremes as they impact the clinical settting.
“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.”
The pursuit of beauty
Maralyn Druce, Anthony P Goldstone, Tricia M M Tan, Karim Meeran
The Lancet, February 16, 2008, Volume 371
Written by Anna Sophia McKenney