(Reuters Health) – Although the U.S. requires prescriptions for topical steroids with more than a 0.5% concentration, much stronger and potentially harmful steroid creams are not hard to find without a prescription, doctors report.
The products are easily available on websites such as Amazon.com and eBay.com and in local stores catering to immigrants and expats from other countries, the study authors write in a letter to JAMA Dermatology, published online November 1.
“We were alarmed when we realized how easily accessible these products were online and that there was no indication there could be serious repercussions,” said a coauthor of the letter, Dr. Cynthia DeKlotz of Georgetown University School of Medicine in Washington, DC.
“Patients need to know that any over-the-counter product – such as herbals, pills, vitamins, creams and supplements – could be harmful,” she told Reuters Health in a phone interview. “Use them with caution and take time to discuss them with your healthcare providers.”
DeKlotz and her colleagues write about their experience with a patient who had recurrent atopic dermatitis that was aggravated by a bacterial infection.
The doctors suggested treatment with a 0.1% triamcinolone cream, which didn’t have much effect, so the patient decided on her own to switch to a triple combination cream called Funbact-A. She bought the cream from a local store that carried products from African countries, and it contained prescription-strength betamethasone, a class 3 topical steroid, according to DeKlotz.
“Her family was from an African country, and she said it was a product they used at home and could get at local stores in the DC area,” DeKlotz said. “We realized this could be a cultural norm and there weren’t concerns about serious side effects.”
The patient had only been using the high-strength cream for a few days before her appointment, so she didn’t experience any problems, but the doctors suggested that she stop using it.
When corticosteroid cream is applied to the skin, both prescription-strength and over-the-counter product labels suggest using the creams on a limited area of the skin for a limited period of time. Using a potent formula on a large skin area can cause additional skin problems or lead to broader hormonal problems.
“In our job as doctors, we often focus on treating a disease, but we need to take time to ensure our patients are safe and try to make the public aware if a trend is happening on a regular basis,” DeKlotz said.
The letter authors searched online and found unregulated topical steroid creams marketed to patients from Africa, China and India for cosmetic purposes. They’re typically used as bleaching agents and often for extended periods of time, the authors note. Others are marketed as “magical” acne creams that show results in a few days.
“I hadn’t heard about this, and I was shocked to see dozens of products listed on eBay, including residents within the U.S. who are selling them,” said W. Steven Pray, a pharmacy professor and researcher at Southwestern Oklahoma State University of Weatherford, who wasn’t involved in the letter.
“These popular skin care products go for $25 a tube, so people are making a killing on these,” he told Reuters Health by phone. “It’s so prevalent, who can stop it?”
DeKlotz and colleagues reported Funbact-A to Amazon and to the U.S. Food and Drug Administration via MedWatch, an online system that lets consumers report adverse effects from prescription and over-the-counter products. Amazon made the cream unavailable for purchase, although the product page is still searchable, said DeKlotz.
She and her coauthors urge both patients and doctors to similarly report unsafe products to the FDA.
JAMA Dermatol 2017.