The Pharmacovigilance Unit, HSA has received local reports of adverse reactions resulting from use of adulterated cosmetic products. The cases below relate to the experience of some patients.

Local case reports

The cosmetic product, Beauty Express® Miracle Pigmentation Scar Cream was tested by HSA to contain betamethasone dipropionate 0.023%, a potent steroid following reports of adverse drug reactions to the product. A few female patients who purchased the product from a retail shop in Singapore as skin whitener for skin pigmentation developed rashes, redness and skin sensitivity on their face after using the creams for several years. These patients became very dependent on the cream and suffered flares of skin redness and soreness whenever they stopped application of the creams. Clinically, the rashes on their face were very suggestive of “steroid facies” as the skin on their face were red and atrophied with surface telangiectasia. The reporting physician suspected steroid facies and symptoms of steroid withdrawal syndrome when they stopped using the cream. Steroid facies is caused by prolonged use of fluorinated topical steroids on the face. Other side effects of topical fluorinated steroids on the face include perioral and periorbital dermatitis (which manifest as acneiform eruptions around the mouth and eyes).

Betamethasone dipropionate is a very potent corticosteroid as compared to other topical corticosteroids such as hydrocortisone and betamethasone valerate. It can result in Cushing's syndrome, skin atropy and hyperglycaemia. Prolonged and widespread use may also result in reversible hypothalamic-pituitary-adrenal (HPA) axis suppression.

The local company marketing Beauty Express® Miracle Pigmentation Scar Cream was prosecuted by HSA for adulterating the product with betamethasone dipropionate.

When diagnosing an adverse reaction in patients, healthcare professionals are encouraged to take a detailed medical history including the patient's use of cosmetic products.