Unregulated skin-lightening cream use causing topical steroid-induced dermatitis and nodulocystic acne

A woman in her early 30s developed severe facial erythema, telangiectasia, burning sensation and progressive hyperpigmentation after 12 months of using an over-the-counter skin-lightening product labelled 'skin-lightening cream' purchased from a local beauty store. Laboratory analysis confirmed the presence of clobetasol propionate 0.05% w/w, which was not disclosed on the product label. Following discontinuation, she developed painful nodulocystic acne as a delayed complication. Treatment with topical calcineurin inhibitors, emollients, photoprotection and oral doxycycline resulted in partial improvement of erythema and telangiectasia, though acne management remained challenging. This case highlights the significant public health risks posed by unregulated cosmetic products containing undisclosed potent corticosteroids and emphasises the need for increased clinical vigilance and regulatory oversight.