Introduction: Prepubertal gynecomastia is a rare condition characterized by the growth of breast tissue in males as a consequence of early exposure to sexual hormones. When this condition is present, pathological sources of testosterone/estrogen production, such as adrenal or gonadal tumors must be searched for. A few reports have described an association between gynecomastia and substances that produce stimulation of the estrogen receptor, such as lavender and tea tree oil.
Methods: Here we describe the cases of three boys who presented with prepubertal gynecomastia and were chronically exposed to lavender. Two of these boys were exposed to a cologne, named agua de violetas, used by Hispanic communities in the US, and in their countries of origin.
Results: We studied a sample of the cologne used by one of the patients. Analysis of the chemical composition of the agua de violetas cologne was performed using high-performance liquid chromatography as well as off-line mass spectrometric detection. All these, combined with the physical appearance and the smell, determined that the cologne had lavender as an ingredient.
Conclusion: Exposure to estrogenic substances, such as lavender, should be explored in children presenting with prepubertal gynecomastia/thelarche.
We thank Dr. Elizabeth G. Lipman Diaz, Ph.D., for helping in the critical review and drafting of the manuscript.
Funding source: No funding was secured for this study.
Financial disclosure: The authors have no financial relationships relevant to this article to disclose.
Conflict of interest: The authors have no conflicts of interest to disclose.
Alejandro Diaz: Evaluated the patients, ordered laboratory tests, conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted.
Laura Luque: Co-writer, Coordinated literature review, revised and critically reviewed the manuscript.
Zain Badar: Coordinated the chemical evaluation of the lavender sample, and revised the manuscript for submission.
Steve Kornic: Literature review, performed the chemical analysis of the lavender sample.
Marco Danon:Contributed with one of his patients and revised the manuscript.
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