Abstract
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.
Acknowledgments
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.
Contributor’s statement
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.
References
1. Cakan N, Kamat D. Gynecomastia: evaluation and treatment recommendations for primary care providers. Clin Pediatr (Phila) 2007;46:487–90.10.1177/0009922806294800Search in Google Scholar PubMed
2. Rivarola MA, Belgorosky A. Prepubertal and pubertal gynecomastia. www.endopedonline.con.ar. Accessed on April 10, 2014.Search in Google Scholar
3. Bembo SA, Carlson HE. Gynecomastia: its features, and when and how to treat it. Cleve Clin J Med 2004;71:511–7.10.3949/ccjm.71.6.511Search in Google Scholar PubMed
4. Wasniewska M, Raiola G, Galati MC, Salzano G, Rulli I, et.al. Non-classical 21-hydroxylase deficiency in boys with prepubertal or pubertal gynecomastia. Eur J Pediatr 2008;167:1083–4.10.1007/s00431-007-0625-6Search in Google Scholar PubMed
5. Einav-Bachar R, Philip M, Auerbach-Klipper, Lazar L. Prepubertal gynaecomastia: aetilogy, course and outcome. Clin Endocrinol 2004;61:55–60.10.1111/j.1365-2265.2004.02059.xSearch in Google Scholar PubMed
6. Henley DV, Lipson N, Korach KS, Bloch C. Prepubertal gynecomastia linked to lavender and tea tree oils. N Engl J Med 2007;356:479–85.10.1056/NEJMoa064725Search in Google Scholar PubMed
7. Turek C, Stintzing FC. Application of high-performance liquid chromatography diode array detection and mass spectrometry to the analysis of characteristic compounds in various essential oils. Anal Bioanal Chem 2011;400:3109–23.10.1007/s00216-011-4976-5Search in Google Scholar PubMed
8. Cavanagh HM, Wilkinson JM. Biological activities of lavender essential oil. Phytother Res 2002;16:301–8.10.1002/ptr.1103Search in Google Scholar PubMed
9. Stoltz S. Lavandula angustifolia Miller. English lavender. Holist Nurs Pract 2009;23:57–64.10.1097/01.HNP.0000343210.56710.fcSearch in Google Scholar PubMed
10. Braunstein GD. Gynecomastia. N Engl J Med 1993;328:490–5.10.1056/NEJM199302183280708Search in Google Scholar PubMed
11. Goldman R. Drug-induced gynecomastia in children and adolescents. Can Fam Physician 2010;56:344–5.Search in Google Scholar
12. Brody SA, Loriaux DL. Epidemic of gynecomastia among Haitians refugees: exposure to an environmental antiandrogen. Endocr Pract 2003;9:370–5.10.4158/EP.9.5.370Search in Google Scholar PubMed
13. Sherings RJ, Olweny CL, Ziegler JL. Gynecomastia and gonadal dysfunction in adolescent boys treated with a combination chemotherapy for Hodgkin’s disease. N Engl J Med 1978;299:12–6.10.1056/NEJM197807062990103Search in Google Scholar PubMed
14. Robert Tisserand. Tea tree and lavender not linked to gynecomastia. http://roberttisserand.com/publications/general-articles/Published 2008. Accessed on April 13, 2014.Search in Google Scholar
15. Block SL. The possible link between gynecomastia, topical lavender, and tea tree oil. Pediatr Ann 2012;41:56–8.10.3928/00904481-20120110-05Search in Google Scholar PubMed
©2016 by De Gruyter
