Corticoids identification in a lipolytic product promoted by two influencers

Abstract

Two influencers have consulted for abscesses requiring surgery on the faces and thighs which began, respectively, one month and ten days following injections by a Russian cosmetologist, of the so-called “Light Fit”, a lipolytic product. The “Light Fit” is made in South Korea and is available on the internet market. It claims that the composition includes different mineral salts and natural extracts of chestnut and walnut with exception of any other products. This product is frequently used in Russia for its indirect lipolytic action based on the promotion of “rapid breakdown of excessive fat”. Following the surgery of the two patients, the microbiological examination of the specimens allowed the identification of an atypical mycobacterium. We reported here the investigation of the chemical composition of this lipolytic product, which have led to side effects for two internet influencers promoting it, using both high-resolution targeted and untargeted approach. A saddled sample of the “Light Fit” product was furnished by the two influencers. Plasma and urine samples of the two patients were collected during the medical consultation, several weeks following the last injection of the lipolytic product. A sample preparation based on liquid-liquid extraction using acetonitrile and methyl tert-butyl ether was performed for each sample. Subsequently, extracts were analyzed by targeted and untargeted screening using liquid chromatography hyphenated to high-resolution tandem mass spectrometry with electrospray as ion source operating in polarity switching mode and a Q-Exactive Focus® Orbitrap mass spectrometer. The qualitative analysis of the lipolytic injection product allowed identifying glucocorticoids including triamcinolone acetonide and dexamethasone. The other detected chemicals were theophylline, lidocaine and tramadol using both targeted and untargeted approach. The “Light Fit” product was determined to be a normo-osmolar solution. Regarding the biological samples, triamcinolone acetonide was detected as trace amounts in the plasma of the two influencers. Furthermore, paracetamol was detected in urine samples as it was administered to the patients during medical consultation. The qualitative analysis of the lipolytic injection product invalidated the claim of a strictly natural composition. It is nevertheless known that theophylline and lidocaine are widely used as lipolytic agents. A conclusion of the natural or synthetic origin of theophylline, an alkaloid found in tealeaves, cannot be drawn. The synthetic glucocorticoid triamcinolone acetonide detected in the product is known to be a local anti-inflammatory steroid. The detection of trace amounts of triamcinolone acetonide in the plasma of the two patients may be related to the half-life of the compounds, which is higher than 20 days (Shen et al. Ophtalmology 2010;117:2375–2371; Schweitzer et al. Neth J Med 2000;56:12–16). Furthermore, the skin lesions observed at the injection site may be related to the infection by the atypical mycobacterium, highly favored by the local injection of triamcinolone acetonide, which, like other glucocorticoids, decreases immune response to pathogens. This study confirmed the usefulness of high-resolution screening to qualitatively characterize these types of products, a needed step prior to quantification. These two cases highlight the health risk of buying products on the internet with a falsified claim, even for people who promote these products like these two influencers.