First line investigations in adult patients presenting following Melanotan II injections.
Date First Published:
November 9, 2021
Last Updated:
November 9, 2021
Report by:
Dr Jamie Phillips, IMT3 Trainee - Acute Medicine (Salford Royal NHS FT)
Three-Part Question:
What does [a patient presenting with general concerns following administration of a Melanotan injection] warrant as [first line investigation] to [identify commonly associated adverse reactions]?
Clinical Scenario:
A 35 year old male patient presents to ED feeling non-specifically unwell following subcutaneous administration of 'Melanotan II' for the purposes of tanning. He describes hyperpigmentation around the injection site, but otherwise no localising symptoms.
Search Strategy:
Ovid MEDLINE(R) ALL - 1946 to Nov. 01 2021
[Melanotan] AND [alpha-MSH] LIMIT to Humans and English language
[Melanotan] AND [alpha-MSH] LIMIT to Humans and English language
Outcome:
2 literature reviews, and 2 related case reports.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Risks of unregulated use of alpha-melanocyte-stimulatinghormone analogues: a review Habbema, L. et al 2017 Netherlands | Male and female patients ranging from 16-54, using Melanotan II for aesthetic purposes. | Literature review | Review of risks associated with Melanotan use | Predominantly eruptive melanocytic naevi. Concerning lesions warranted dermatology follow up as with any other concerning skin lesion. Only hypothetical causal relationship identified. | Incredibly brief mention of non-dermatological adverse reactions to Melanotan use. |
| Melanotan Tanning Injection: A Rare Cause of Priapism Mallory, C. W. et al. 2021 United States | 55 year old male, with no predisposing risk factors, attending with priapism following subcutaneous injection of 2mg Melanotan II. | Case report | Individual case report. | ||
| Melanotan-induced priapism: a hard-earned tan Dreyer, B. A. et al. 2019 United Kingdom | 41 year old male, with no predisposing risk factors, presenting to ED with priapism following subcutanoue injection of an unknown dose of Melanotan II. | Case report | Individual case report | ||
| Melanotan II: a possible cause of renal infarction: review of the literature and case report Peters, B. et al. 2020 | 45 year old male presenting with abdominal pain and vomiting. Imaging ultimately showing renal infarction. Contributing factor thought to be Melanotan II use. | Case report, following by literature review involving 20 papers relating to melanotropic peptides and association with renal pathology. | Acknowledged limitation that no quantitative level of Melanotan, or its active metabolites, was measured at presentation. |
Author Commentary:
There is increasing illicit use of Melanotan II in tanning, weight management, and sexual dysfunction.
The majority of literature relates to dermatological adverse reactions to Melanotan, predominantly eruptive melanocytic naevi. A number of these lesions have later been identified as malignant.
A small number of renal insults, either infarct or due to rhabdomyolysis, have been described in case reports.
Priapism warranting urological intervention has also been described in case reports.
The majority of literature relates to dermatological adverse reactions to Melanotan, predominantly eruptive melanocytic naevi. A number of these lesions have later been identified as malignant.
A small number of renal insults, either infarct or due to rhabdomyolysis, have been described in case reports.
Priapism warranting urological intervention has also been described in case reports.
Bottom Line:
The most commonly reported adverse reaction to the use of Melanotan is dermatological in nature. If skin lesions seen are concerning for malignancy, then a two week wait referral to dermatology for consideration of biopsy would be indicated.
Routine blood tests, specifically assessing renal function, are indicated. Though cases of renal pathology reported in the literature present with localising symptoms.
Priapism will without doubt present with a localising symptom, and should be managed accordingly.
Routine blood tests, specifically assessing renal function, are indicated. Though cases of renal pathology reported in the literature present with localising symptoms.
Priapism will without doubt present with a localising symptom, and should be managed accordingly.
References:
- Habbema, L. et al. Risks of unregulated use of alpha-melanocyte-stimulatinghormone analogues: a review
- Mallory, C. W. et al.. Melanotan Tanning Injection: A Rare Cause of Priapism
- Dreyer, B. A. et al.. Melanotan-induced priapism: a hard-earned tan
- Peters, B. et al.. Melanotan II: a possible cause of renal infarction: review of the literature and case report