Farmacos

Question 1

10: A 25-year-old woman presented with slowly increasing, hypo- and hyperpigmented, atrophic, linear marks on her upper arms. She admitted to having been applying a bleaching cream to the affected areas for the last 2 years, which she had purchased in a pharmacy in Africa. This cream contained which of the following ingredients?

1. Mercury
2. Hydroquinone
3. Sunscreen
4. Clobetasol propionate

Answer 1

4 - Clobetasol propionate

• Skin-lightening procedures work by reducing the concentration or production of melanin in the skin. Safe over the counter products may include kojic acid, arbutin, licorice extract and hydroquinone (less than 2%).
• Topical corticosteroids can lighten skin color, and moderate potency fluocinolone is included in a prescription treatment for melasma together with hydroquinone 4%, and tretinoin.
• Use of potent and ultrapotent topical corticosteroids in lightening creams is unregulated and risks severe local and systemic side effects. In this case, severe striae atrophicae were caused by long-term use of clobetasol propionate.
• Patients continue to present with adverse effects due to corticosteroids, mercury, and high-potency hydroquinone in bleaching products that they have obtained from unscrupulous vendors. Ingredients may be undeclared or hidden.