Undeclared Clobetasol Detected in 6 of 18 Online OTC Skin Products

The superpotent, prescription-only corticosteroid clobetasol propionate was detected in 6 of 18 over-the-counter (OTC) skin products purchased online, and none disclosed the drug on its label, according to a research letter published in JAMA Network Open.

Investigators from Beth Israel Deaconess Medical Center and Harvard Medical School noted that numerous OTC products marketed online claim benefit for psoriasis, eczema, and hyperpigmentation despite lacking clinically proven active ingredients.

For the quality improvement study, investigators selected products that claimed efficacy for inflammatory or persistent skin conditions, listed no clinically proven ingredients for those conditions, and had at least 100 reviews on 1 or more platforms. Products previously reported to contain undeclared ingredients, or with similar branding or labeling, were included if they met at least 1 criterion. Samples were screened for 28 corticosteroids and antifungals using high-resolution liquid chromatography–mass spectrometry. Clobetasol propionate concentrations ranged from approximately 0.01% to 0.46%, and the highest exceeded the 0.05% concentration of FDA-approved topical formulations by 9.2-fold. Two products also contained the antifungals miconazole or terbinafine.

Three positive products—Neoprosone gel, cream, and serum—were marketed for skin brightening, while Qian Nian Qi Cao, Psor-Val, and Zudaifu were marketed for conditions including psoriasis and eczema. Positive products had more than 10,000 combined user reviews. The authors noted that skin-lightening products are commonly applied to the face, where corticosteroid absorption is increased, and that periocular exposure has been associated with glaucoma. Unsupervised chronic exposure to potent corticosteroids may cause skin atrophy, steroid acne, dyspigmentation, and hypothalamic-pituitary-adrenal axis suppression, they added.

Because products were preselected for a higher likelihood of containing undeclared ingredients, the authors said the 33.3% detection rate reflects the yield of a targeted assessment rather than US market prevalence. Other limitations included the small number of products and possible failure to detect alternative chemical forms. The authors wrote that the findings suggest regulatory and surveillance approaches remain insufficient.

Source: Abilov Z, James MJ, Porter ML, Popov YV. Undeclared pharmacologically active ingredients in over-the-counter skin products. JAMA Netw Open. 2026;9(10):e2638654. doi:10.1001/jamanetworkopen.2026.38654