Skin products from dubious or unknown sources can cause serious adverse effects

Eczema, psoriasis and other skin issues can cause great discomfort and debilitating effects in those afflicted with such conditions. Besides treatments prescribed by doctors, a wide variety of products are sold and marketed at pharmacies and retail outlets to help relieve the symptoms. Some consumers may also purchase these products from local or overseas online platforms and other sources.

Risks of online purchases

If buying online, you may come across positive reviews or recommendations from influencers or testers of such products. They may also promise quick, miraculous solutions. While it may be tempting to try these products, do bear in mind that it is often difficult to verify such reviews. You cannot be certain if the products will deliver the promised results or if they are safe to use.

There is also no means for consumers to verify the actual contents of such health products on their own as only laboratory tests can do so. Consumers need to be especially wary of health products from dubious or unknown sources. They may be adulterated with potent ingredients that can cause serious harm to you.

HSA has detected several of such adulterated products. Certain groups of people such as young children and the elderly are more vulnerable to the effects of adulterants such as steroids, and they may suffer serious adverse effects from the use of creams adulterated with steroids or other potent ingredients.

Importance of professional medical advice

Your doctor or pharmacist are best positioned to advise you on the treatment choices and the products. Some skin conditions, particularly chronic ones like eczema and psoriasis, may need to be managed by medical professionals as they can diagnose the root cause and advise on the appropriate treatments. Not seeking medical advice may lead to the inappropriate use of wrong products and result in worsening of symptoms or may even cause serious adverse effects such as hypertension, poor control of blood sugar and cataracts.

Adulterated skin products tested to contain potent ingredients that have caused adverse effects

From 2022 to August 2024, HSA had detected various skin products adulterated with potent ingredients. This comprised about 25% of all adulterated products detected by HSA. Of these, 5 skin products led to adverse effects, with 3 consumers hospitalised. Many of these adulterated skin products were sold online. HSA has removed the online postings on adulterated skin products and issued warnings to sellers. The supplier of one of the adulterated products, “Star Cream” was prosecuted and sentenced to a total fine of $18,000.

1. “Skin-Cap^® Cream” and “Skin-Cap^® Spray”(2024)

Product Claims:

Cream: Formulation specially designed for the moisturising of dry skins affected by desquamation caused by diverse dermatological processes

Spray: For relief of itching, irritation, redness, flaking and scaling associated with skin conditions

Product Source: Purchased online

Potential adverse effects:

• Cataracts

• Cushing’s syndrome (characterised by a round face or ‘moon face’ and upper body obesity with thin limbs)

• High blood pressure

• Increased blood glucose levels (which may lead to diabetes)

• Increased risk of infections

• Muscular and bone disorders (including osteoporosis)

Adulterants detected by HSA:

• Diflorasone-21-propionate (steroid)

2."88 Total White Underarm Cream" (2024)

Consumer: Woman in her 30s who used this cream for a month

Product Claims: Whiten and smoothen skin and reduce body odour

Product Source: Purchased from local retail shop

Adverse effects:

• Allergic contact dermatitis and DRESS syndrome (characterised by skin rash, blood abnormalities and multi-organ involvement e.g., injury to the liver and/or kidney, which can be life-threatening) leading to hospitalisation

• Liver impairment with raised liver enzymes and jaundice

Adulterants detected by HSA:

• High levels of mercury (toxic heavy metal)

• Betamethasone (steroid)

• Salicylic acid (anti-acne and exfoliating agent)

3. “EUZEMA Confidence Revival Cream” (2023)

Consumer: Man in his 30s who used the cream for his eczema for a year

Product Claims: Able to beat eczema for good with this powerful natural formula, is steroid-free, contains 100% all-natural herbs and has no side-effects

Product Source: Purchased online

Adverse effects:

• Skin reaction known as purpura (purplish red spots due to small bleeds under the skin)

Adulterants detected by HSA:

• Arsenic (toxic heavy metal; present in over 430 times higher than the allowable limits[1])

• Betamethasone (steroid)

• Salicylic acid (anti-acne and exfoliating agent)

4. “Star Cream (星星膏)” (2022)

Consumer: Four-month-old infant who had “Star Cream (星星膏)” applied on him for diaper rash since he was two weeks old

Product Claims: Homemade, containing natural herbal extracts, with antibacterial and antifungal properties and no steroids, suitable for all skin types, including skin conditions such as acne, eczema, mosquito bite, psoriasis and skin ringworms

There were also multiple consumer reviews on e-commerce platforms regarding its quick relief of various chronic skin conditions.

Product Source: Purchased online

Adverse effects:

• Persistent vomiting, abnormal eye alignment (convergent squint) and a bulging fontanelle (the soft spot on top of a baby’s skull), consistent with signs of increased brain pressure

• Required long term follow-up due to steroid toxicity

• Steroid toxicity leading to Cushing’s syndrome and hospitalisation

Adulterants detected by HSA:

• Clobetasol propionate (steroid)

• Ketoconazole (antifungal)

What to look out for when purchasing or using skin products

Follow the A-L-E-R-T steps to check that you are not endangering your health:

• AVOID Dubious Products: Steer clear of products from unknown or unverified sources, especially online. You cannot be certain where and how these products were made and whether they have been adulterated with harmful ingredients.

• LOOK for Reputable Sellers: Only purchase from trusted pharmacies or well-known retailers with an established presence in Singapore.

• EXAMINE Claims: Be cautious and wary of products that claim to have miraculous results or “no side effects”.

• REPORT Suspicious Products: Help protect others by reporting dangerous or dubious products to HSA.

• TRUST Medical Advice: Seek advice from a healthcare professional and avoid self-medicating with unknown products.

You can help us combat adulterated and substandard health products. Report any suspicious health products to HSA’s Enforcement Branch at Tel: 6866-3485 during office hours (Monday to Friday) or email: hsa_is@hsa.gov.sg.

[1] https://www.hsa.gov.sg/traditional-medicines/overview/