Unauthorized skin lightening and skin treatment products may pose serious health risks

Aminocaproic acid is a prescription drug used to decrease bleeding in various clinical situations. Aminocaproic acid has not been approved for topical use in Canada. Exposure to aminocaproic acid on the skin may affect the skin, and the drug may be absorbed through the skin into the blood. Side effects may include a general feeling of discomfort, muscle aches and pain, kidney damage, seizures, low blood pressure, slow heart beat, blood clots, and swelling caused by fluid build-up.

Betamethasone dipropionate, betamethasone valerate and clobetasol propionate are highly potent corticosteroid prescription drugs that are applied to the skin to treat inflammatory skin conditions. Side effects include skin irritation and, with prolonged use, skin weakening or deterioration. Adverse effects from using too much include decreased ability to fight infection, symptoms of adrenal gland suppression (i.e., low blood pressure, low blood sugar, weight loss, muscle pain, gastrointestinal problems and severe fatigue) or Cushing's syndrome (i.e., high blood pressure, high blood sugar, weight gain, muscle weakness, bone loss and severe fatigue), depending on how much has been absorbed. These drugs should not be used by pregnant or nursing people.

Dexamethasone is a prescription corticosteroid drug available in Canada as tablets, injections, and eye ointments, and is used to treat inflammatory conditions or to suppress the immune system. Dexamethasone as an ointment is not approved as an anti-itch medication. Side effects for topical corticosteroids include skin atrophy (thin and fragile skin with reduced elasticity), skin blood vessel changes (e.g., spider veins), skin colour changes, stretch marks, swelling, dry skin, burning sensations, local irritation, rashes, redness, itching, thinning hair or excessive hair growth, infections and allergic reactions. Topical corticosteroids absorbed through the skin may cause side effects throughout the body, especially when used over a large surface area and for a long time. This risk is greater in children, who may absorb proportionally larger amounts and be more susceptible to experiencing these side effects. Systemic side effects could include high blood pressure, high blood sugar, blurred vision, uneven heartbeats, weakness and swelling. Dexamethasone should not be used by people who are allergic to dexamethasone or to any ingredient in the formulation, people who have systemic fungal infections, or people who have received live virus vaccines. Dexamethasone is generally not recommended for use during pregnancy.

Erythromycin is an antibacterial prescription drug used for the prevention and treatment of specific infections. In topical format (applied to the skin), it is used in combination with another drug to treat moderate acne. Possible reactions include local skin irritation (peeling, itching, burning sensation, redness or tenderness) or other skin changes (change in colour, oiliness or swelling), inflammation, or irritation of the face, eyes and nose. Symptoms of a severe allergic reaction include swelling of the face, mouth, throat, lips and/or eyes, difficulty breathing, burning and/or painful red eyes, eye tearing and skin reactions (rashes, blisters and hives). Misuse or overuse could lead to bacteria growth that could become resistant to the antibiotic erythromycin, which means that treatment may not work in the future.

Hydroquinone is a prescription drug when it is greater than a 2% concentration and a natural health product at a concentration of 2% and under. It is used topically (applied to the skin) to lighten areas of darkened skin caused by different conditions (e.g., sun exposure, skin damage, pregnancy, medications or age). It should not be used by people who are allergic to hydroquinone or who are taking medicines that make their skin more sensitive to light. Hydroquinone is not recommended for pregnant or breastfeeding people, or for children. It should be used with caution in those who have previously had cancer. Side effects include skin reactions such as redness, dryness, cracked skin, burning, stinging, peeling, itching, increased sensitivity to sunlight, sunburn, blisters and scarring. It may cause skin discolouration (i.e., blue or black discolouration or white patches or spots) that, in some cases, can be disfiguring. In laboratory animals, it has been associated with cancer after long-term exposure.

Ibuprofen piconol 3% is a topical (applied to the skin) non-steroidal anti-inflammatory drug (NSAID) used to relieve burns. Health Canada has not approved any drugs containing ibuprofen for topical use. Ibuprofen absorbed through the skin may cause side effects throughout the body, especially when used over a large surface area and for a long time, or on damaged skin. Topical ibuprofen may cause serious side effects in people who are allergic to ibuprofen, aspirin or other NSAIDs, or who are asthmatic. Use of topical ibuprofen may also cause serious side effects such as stomach and intestinal bleeding, renal (kidney) dysfunction or failure, or cardiovascular dysfunction or failure in people who have problems with these organs. Topical ibuprofen can also cause serious side effects in people who are pregnant or breastfeeding, such as delayed and increased duration of labour.

Ketoconazole is a prescription antifungal drug typically used to treat skin and scalp infections. It should be used only under the supervision of a health care professional. When applied to skin, common side effects include severe irritation, itchiness and stinging. Contact dermatitis (an itchy or painful rash) and painful allergic reactions have been reported more rarely. Ketoconazole should not be used by pregnant or breastfeeding people unless directed by a health care professional.

Neomycin sulfate is an antibiotic prescription drug and should be used only under the supervision of a health care professional. Side effects include allergic reactions that range from mild skin reactions (itching, rash and hives) to severe, life-threatening allergic reactions (anaphylaxis). Side effects such as damage to nerve tissue or the central nervous system, inner ear, and organs responsible for hearing and balance, and reduced kidney function have occurred in patients taking neomycin orally (by mouth) or when applied on the skin to open wounds or damaged skin. As well, when not used as directed, neomycin sulphate could increase the risk of infections resistant to neomycin or other antibiotics. Neomycin sulphate should not be used by pregnant or breastfeeding people unless directed by a health care professional.

Penicillin potassium is an antibacterial prescription drug used for the prevention and treatment of specific infections. Penicillin has not been approved for use in ointments for topical use in Canada. Allergic reactions to penicillin may include swelling of the face, mouth, throat, lips, eyes, difficulty breathing and skin reactions (itchiness, flushing, hives), abdominal distress (cramping, nausea, vomiting or diarrhea) and low blood pressure. Serious and occasionally fatal hypersensitivity (anaphylactoid) reactions have been reported in patients receiving penicillin. Severe skin reactions that may also affect other organs have been reported in association with penicillin. Prolonged use of antibiotics may lead to yeast or fungal overgrowth. Misuse or overuse of penicillin may lead to the growth of bacteria that will not be killed by penicillin (resistance). This means that penicillin may not work in the future.

Prednisolone valerate acetate is a prescription corticosteroid drug available in Canada as eye drops used to treat inflammation of several parts of the eye. It has not been approved for use in creams or ointments in Canada. Common side effects for topical corticosteroids include skin atrophy (thin and fragile skin with reduced elasticity), skin blood vessel changes (e.g., spider veins), change in skin color, stretch marks, swelling, dry skin, burning sensation, local irritation, rash, redness, itching, thinning hair or excessive hair growth, infections and allergic reactions. Topical corticosteroids absorbed through the skin may cause side effects throughout the body, especially when used over a large surface area and for a long time. This risk is greater in children, who may absorb proportionally larger amounts and be more susceptible to side effects. Systemic side effects could include high blood pressure, high blood sugar, blurred vision, uneven heartbeats, weakness, and swelling. Prednisolone acetate should not be used in patients who are allergic to prednisolone acetate or to any ingredient in the formulation. Prednisolone acetate is not to be used in children and is not recommended for use during pregnancy or breastfeeding.

Tretinoin in topical format (applied to the skin) is a prescription drug used to treat acne. Topical tretinoin should not be used during pregnancy as it has been associated with birth defects. It should also not be used by those who are breastfeeding or by children under 12 years old, or by individuals who have inflamed or irritated skin, have a previous skin cancer or undiagnosed skin lesions, who are taking medicines that make their skin more sensitive to light, or who have an allergy to tretinoin. Tretinoin may cause pain, irritation, itchiness, redness, or swelling at the site of application. It may damage skin, change skin colour, and increase sensitivity to sunlight or tanning beds, causing sunburns. Using tretinoin in combination with hydroquinone may increase some of the side effects of tretinoin.