An article, co-authored by 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, underlines the perils of using skin lightening creams sold on the black market. The article is published in the February issue of The Lancet.

The article describes the story of a 28-year-old woman who had gained 12.7 kg (28.0 lb) in the previous 3 years who 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. According to the report 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 7 years. The patient said she bought the cream from a local shop that was selling it illegally. 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.

"Patients are often reluctant to admit that they have used skin-lightening creams—especially if these are supplied illegally," say the authors. "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."

[www.medicalnewstoday.com, February 20, 2008]