Hidden steroids found in popular skin creams

Clinical takeaway: Ask patients with chronic eczema, psoriasis, or skin-lightening product use about over-the-counter creams purchased online, especially if they report dramatic results or unexplained steroid-related adverse effects. Undeclared prescription-strength corticosteroids may be more common than clinicians realize.

Millions of Americans use nonprescription skin products marketed for conditions such as eczema, psoriasis, and hyperpigmentation. While some products promise benefits despite lacking proven active ingredients, regulators and researchers have repeatedly uncovered hidden drugs that may expose consumers to significant risks without medical supervision.

In a targeted quality-improvement study, researchers purchased 18 over-the-counter skin products from major online retailers that claimed benefits for inflammatory skin conditions or skin lightening but did not list clinically proven active ingredients. Laboratory testing found undeclared pharmacologically active ingredients in 6 products, representing 33% of the sample. Every positive product tested positive across all three units analyzed.

All six contaminated products contained clobetasol propionate, a prescription-only superpotent (class I) topical corticosteroid. Two products also contained hidden antifungal agents. Clobetasol concentrations ranged from about 0.01% to 0.46%, with the highest levels exceeding the concentration found in FDA-approved clobetasol products by more than ninefold. None of these active ingredients appeared on product labels.

Three of the positive products were marketed as skin-brightening treatments, raising concerns about chronic facial and periocular exposure. The authors noted that unsupervised use of potent topical steroids can lead to skin atrophy, steroid acne, pigment changes, and suppression of the hypothalamic-pituitary-adrenal axis. Products testing positive had substantial consumer reach, accumulating more than 10,000 online reviews and including several top-selling items in their categories.

“Products containing [undeclared pharmacologically active ingredients], including superpotent corticosteroids, may remain available to consumers until they are identified through targeted surveillance or adverse-event reporting,” the authors wrote.

Source: Abilov Z, et al. (2026 Oct 8) JAMA Netw Open. Undeclared Pharmacologically Active Ingredients in Over-the-Counter Skin Products