Pumped and Tanned

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.