Buyer Beware or You Might Get Burned: Unregulated Photosensitizing Agents Available Without Prescription From Major Online Retailers
Kimberly Huerth, MD, MEd, Department of Dermatology, Howard University Hospital, Washington, DC; Olivia Ware, BA, Howard University College of Medicine, Washington, DC; Ginette A. Okoye, MD, Department of Dermatology, Howard University Hospital, Washington, DC; Sharon Bridgeman-Shah, MD, Department of Dermatology, Howard University Hospital, Washington, DC
Disclosures: None.
Kimberly Huerth, MD, MEd
Background
According to the World Health Organization, the vast majority of the world’s population relies on plant-derived medicine as their primary form of healthcare. Closer to home, these alternative therapies are growing in popularity among American healthcare consumers, in concert with increasing access to such products by means of globalization and the growth of Internet retail. There are numerous reasons why an individual might eschew Western medicine in favor of a more naturopathic approach, including perceived health benefits, cost, prior failure of physician guided treatment, a lack of awareness about the risks these products carry, cultural norms, and desperation born of the psychosocial burden of one’s disease.
A 73-year-old Eritrean man presented to our outpatient dermatology clinic with a severe, acute, phototoxic reaction following the ingestion of Athamanta decoction for the self-directed treatment of vitiligo. The genus Athamanta is in the Apiaceae family and consists of 6 species of flowering plants native to Europe and North Africa. Furanocoumarins are the phototoxic compounds present in these plants, among which psoralen is perhaps the most notorious. The desiccated Athamanta leaves, sought in the absence of medical consultation, had been obtained from a mail order vendor in Egypt which had advertised them as a “miracle effect for curing vitiligo.”
Objective
To determine the extent to which unregulated photosensitizing agents for the treatment of vitiligo are available to consumers from online retailers, including major ones such as Amazon and eBay.
Methods
An online product search of eBay and Amazon, as well as an Internet pharmacy by the name of Cheap Generic, was conducted using search terms “vitiligo treatment,” “psoralen for vitiligo,” “furanocoumarin treatment,” “Athamanta vitiligo,” “Apiaceae vitiligo,” and “leukoderma.” Products generated by the search terms were examined for their route of delivery (topical vs systemic), key photosensitizing ingredient, parent plant, cost to consumer, and country of manufacture. Products that did not identify a known photosensitizing compound, or a plant known to contain a photosensitizing compound, on the list of ingredients were excluded from the analysis.
Results
We identified a total of 11 products—6 listed on Amazon, 3 listed on eBay, and 2 listed by Cheap Generic pharmacy—that had either a photosensitizing compound, or a plant known to contain a photosensitizing compound, on its list of ingredients. 27.3% of products were available in formulations intended for ingestion, such as tablets or powders. 90.9% of products listed psoralen, or a plant known to contain psoralen, as a major ingredient. Of the products that identified the main photosensitizing plant ingredient (72.7%), Psoralea corylifolia was the most common (75%). Products ranged in cost from $3 to $28. The terms “herbal” (54.5%) and “natural” (36.3%) were used most frequently on the packaging and/or website for promotional purposes. While 45.4% of products did not identify a country of origin, of those that did, 66.7% were manufactured in India, while the remainder were prepared in China.
Conclusion
Topically and systemically administered psoralen-containing products for the treatment of vitiligo are widely available without a prescription from several online vendors. These products are affordable and utilize suggestive packaging to tout the benefits of the products, without mention of their risks.
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