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Betamethasone and hydrocortisone together. In a clinical trial the 1980s, drug was found to be effective for a variety of dermatological conditions, including psoriasis, acne, eczema, dandruff, cellulite, acne scars, and eczema. But the drug had a downside: It can produce side effects such as nausea, weight loss, and even death. In response, Merck scientists developed a new skin-whitening agent that would act only when applied to the skin. They called it Accutane, and was approved in November 1998. Merck used the drug to combat psoriatic arthritis (an autoimmune disease) and to treat psoriasis. But the drug failed to prevent recurrence of psoriasis. In 2001, Merck scientists developed a second, more powerful, and effective skin-whitening agent. It is called Accutane II. was approved by the FDA in February 2004. It works by stimulating the production of melanin in melanocytes, which produce the pigment melanin, in skin. This means that the drug works for only a short time before the skin returns to normal. But Merck says that Accutane II is more effective than Accutane at preventing skin whitening. Now, Merck scientists believe they have discovered an effective alternative to Accutane: topical 2,4-D. The drug was initially developed by Merck for use in cattle, but scientists soon found that it was being used to treat a variety of disorders, including Crohn's disease, arthritis, chronic obstructive pulmonary disease (COPD), and multiple sclerosis. But the drug has proven to be less effective against melanin production than Accutane. The new study from Merck's dermatology department involved 16 patients with skin cancer, all of whom were treated with 2,4-D and then tested again six months later. Patients in the study who had a higher level of melanin in their skin prior to Accutane treatment showed a significantly greater reduction in their melanin levels six months later. Merck scientists believe that topical 2,4-D could be used to treat the skin-whitening properties of Accutane and II. because the drug is not absorbed by the skin in same way as Accutane, Merck believes that the drug could be available for sale in as little three years. The skin-whitening agent could also be used to treat other skin disorders, such as melasma, eczema, and psoriasis. In addition, Merck researchers are studying the use of 2,4-D to treat human skin cancers, such as melanoma and lung tumors. The study was funded by National Institutes of Health and conducted by researchers from Merck's Dermatology Department, the Department of and Proctology at Washington University School of Medicine in St. Louis, and the Department of Dermatology Proctology at Washington University School of Medicine in St. Louis.

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