Pumped and Tan, Melanotan Man
Presented by Dr. M. Chester Morris
Cosmetic and Aesthetic Dermatology Centre
Nanaimo, British Columbia, Canada
A 42 yo Man presented with a history of new naevi on torso a
few months
He was in good general health. His only medication was oral minoxidil, 5 mg
a day, for male pattern alopecia.
O/E: About a dozen naevi,
5 – 7 mm in diameter,
were scattered on his torso.. They were clinically benign appearance, but
as it is unusual for a 42 year-old individual to have eruptive naevi. The most
atypical one was biopsied.
Pathology shows a junctional and compound nevus without atypia.
The patient is well-known to our clinic.
He has a history of
- Ongoing mild alopecia
areata of the bearded area and receives ILK every few months.
- Mild male-pattern
alopecia. He’s had 3 hair
transplants, 2 locally and one at a specialty clinic in Southern
California where they do PRP
- Expensive cosmetic dental
capping
He spends lots of time in the gym (uses supplements)
Further history reveals that he bought Melanotan. a synthetic analogue of the peptide hormone
α-melanocyte-stimulating hormone (α-MSH) that stimulates melanogenesis and is
purported to increases sexual arousal among other things, at his gym
and has been injecting himself with it for a few months. When I asked to see the product, he said he
couldn’t find it.
Diagnosis: This 42 yo man developed Eruptive Melanoytic Naevi
after the use of Melanotan obtained from a contact at his gym. When I expressed interest in the drug; he
disappeared. I have known him for a few years and he appears to have body
dysmorphic syndrome (BDD) and that may have induced him to purchase Melanotan. His form of BDD has been called “Muscle
Dysmorphia” or The Adonis Complex.
Teaching points:
1. Use of Melanotan may be more widespread than we realize.
2. Patients such as this may have BDD, specifically the
Adonis Syndrome
3. There is an online
literature on Melanotan and although it is risky, some patients nonetheless
seek it out.
The medical literature contains references to various
possible side-effects of Melanotan. These include: darkening of previous naevi, eruptive melanocytic naevi,
isolated cases reports of melanoma and melanoma in situ, renal infarcts,
and priapism.
Reference:
1. Ewa A Burian 1 ,
Gregor B E Jemec Eruptive Melanocytic
Nevi: A Review. Am J Clin Dermatol. 2019 Oct;20(5):669-682.
Abstract: Eruptive melanocytic nevi (EMN) is a phenomenon
characterized by the sudden onset of nevi. Our objective was to compile all
published reports of EMN to identify possible precipitating factors and to
evaluate the clinical appearance and course. We conducted a systematic
bibliographic search and selected 93 articles, representing 179 patients with
EMN. The suspected causes were skin and other diseases (50%); immunosuppressive
agents, chemotherapy or melanotan (41%); and miscellaneous, including
idiopathic (9%). The clinical manifestations could largely be divided into two
categories: EMN associated with skin diseases were frequently few in number
(fewer than ten nevi), large, and localized to the site of previous skin
disease, whereas those due to other causes presented most often with multiple
small widespread nevi. In general, EMN seem to persist unchanged after their
appearance, but development over several years or fading has also been
reported. Overall, 16% of the cases had at least one histologically confirmed
dysplastic nevus. Five cases of associated melanoma were reported. We conclude
that the clinical appearance of EMN may differ according to the suggested
triggering factor. Based on the clinical distinction, we propose a new
subclassification of EMN: (1) widespread eruptive nevi (WEN), with numerous
small nevi, triggered by, for example, drugs and internal diseases, and (2)
Köbner-like eruptive nevi, often with big and few nevi, associated with skin
diseases and most often localized at the site of previous skin disease/trauma.
The nature of the data precluded assessment of risk of malignant
transformation.
2. Melanotan https://en.wikipedia.org/wiki/Melanotan_IIWikipedia
3. Harrison G Pope Jr, Katharine
A Phillips & Roberto Olivardia, The Adonis Complex: The Secret Crisis of
Male Body Obsession (New York: Free Press, 2000)
4. Muscle Dymorphea: https://en.wikipedia.org/wiki/Muscle_dysmorphia
5. Louis Habbema et.
al. Risks of unregulated use of
alpha-melanocyte-stimulating hormone analogues: a review. Int J Dermatol. 2017
Oct;56(10):975-980.
Abstract
Recently, the unregulated use of untested synthetic
alpha-melanocyte-stimulating hormone (α-MSH) analogues, commonly known as
melanotan I and II, appears to have increased. These analogues are primarily
used for their tan-stimulating effects. Dermatologists see many patients in
their clinic who tan. This review provides an overview of the risks of the
unregulated use of these substances. Although
afamelanotide has been thoroughly tested and deemed safe, illegal melanotans
are likely risky for several reasons. There are questions regarding the
preparation, administration, and dosage of these substances. In addition to
these general risks, increasing numbers of case reports indicate that the
unregulated use of both melanotan I and II is associated with cutaneous
complications, particularly melanocytic changes in existing moles and newly
emerging (dysplastic) nevi. Four case reports have described melanomas emerging
from existing moles either during or shortly after the use of melanotan.
Although conclusive evidence linking these phenomena is lacking, publications
have stressed the importance of awareness that melanotan is a part of a
'tanning culture' in certain subpopulations. Multiple national health
organizations have issued safety warnings regarding the use of melanotan I and
II.
