Unregulated use of clobetasol propionate

SIR, Imported superpotent topical steroids are sold for use as skin‐lightening agents at certain street markets in London. We describe a patient who developed striae and adrenal suppression following the purchase and inappropriate use of clobetasol propionate. A 46‐year‐old Afro‐Caribbean woman had a 3‐month history of a hyperpigmented patch on her left forearm, and was prescribed topical beclomethasone dipropionate (Propaderm®; Glaxo Wellcome, Uxbridge, U.K.) by her general practitioner for presumed eczema. As the hyperpigmentation did not resolve, she purchased an ointment called Movate® at a local market selling unlicensed products, seemingly imported from Italy. The tube was labelled as 0·05% clobetasol propionate and the cream was described as ‘anti‐inflammatory, antiallergic, antipruritic’ and particularly indicated in the ‘treatment of the most resistant dermatoses’. She was not taking any other medications at that time. The patient applied in total 30 g Movate ointment to the plaque, and began to notice the development of striae in the axillae and inner upper arms, which were progressive. At presentation to our clinic, the initial plaque had cleared but there was residual skin atrophy and telangiectasia at this site. She was otherwise well, blood pressure was normal and she did not demonstrate any symptoms or signs of adrenal dysfunction.