Online Skin Products May Contain Hidden Drug Ingredients

Zaur Abilov, M.D., of Beth Israel Deaconess Medical Center in Boston, led a targeted examination of 18 nonprescription skin products available online. Testing found unlisted, pharmacologically active substances in six products. For every product with a positive result, the ingredient appeared in each of the three units analyzed. None of the clinically established active ingredients appeared on the labels.

All six positive products contained clobetasol propionate, a class I, prescription-only corticosteroid described as superpotent. Two also had an antifungal ingredient—either miconazole or terbinafine. The smallest clobetasol level was about 0.01%, while the largest was roughly 0.46%. At the upper end, the amount was 9.2 times the concentration used in topical formulations approved by the U.S. Food and Drug Administration.

The six products had collectively received over 10,000 reviews across internet retail sites, showing that these items had reached many online shoppers. The findings matter for adults using nonprescription products over time for chronic skin conditions because the labels did not reveal exposure to these drugs. The authors said affected products can remain for sale until targeted monitoring or reports of adverse events identify them. The study appeared online Oct. 8 in JAMA Network Open.