Premature Pubarche Secondary to Herbal Oil Exposure

Premature pubarche (PP) is characterized by the growth of pubic hair before the age of 8 years in girls and 9 years in boys. In 80 to 95% of cases, PP is related to premature adrenarche (PA) secondary to idiopathic premature secretion of adrenal androgens. Although prepubertal pubarche is considered a variant of normal development, pathological causes should be ruled out, prompting a search for a source of androgen. Although hyperandrogenemia may be endogenous or exogenous in origin, most persons with prepubertal pubarche have normal serum concentrations of sex steroids, and an underlying cause is not identified. In such cases, possible exposure to endocrine disruptors should be considered. We report a case of premature pubarche in a 9-month-old boy who developed isolated pubarche after exposure to an herbal oil containing multiple essential oils including lavender, clary sage, grapefruit and peppermint. Pubarche resolved shortly after the use of herbal oil was discontinued.