A small observational study published in JAMA Network Open found that six of 18 over-the-counter skin products bought online contained undeclared pharmacologically active ingredients. The hidden compounds included clobetasol propionate, a prescription-only superpotent corticosteroid, and two antifungal drugs. None of these ingredients appeared on the product labels.
Clobetasol concentrations ranged from roughly 0.01% to 0.46%, with the highest level exceeding the 0.05% allowed in FDA-approved topical formulations by a factor of 9.2. The affected products had more than 10,000 combined user reviews, and several were top sellers in their online categories. The researchers said the findings indicate that current regulatory and surveillance approaches are insufficient.
Chronic exposure to clobetasol can cause skin atrophy, steroid acne, pigment changes, and suppression of the hypothalamic-pituitary-adrenal axis, and periocular use has been linked to glaucoma. Pieter Cohen of Harvard Medical School, who was not involved in the study, said consumers may turn to these creams instead of seeing a doctor, risking permanent skin damage. He urged the FDA to remove the products from the market.
The authors noted that the study was a targeted assessment, not an estimate of true market prevalence, and the sample size was small. They argued that the approach could still help regulators identify contaminated products and called for greater awareness among patients and clinicians.