The dark side of skin whitening products: Do they work or is it misinformation?

India’s obsession with fair skin is very well-documented and that has created a huge market for skin whitening creams, which has seen a steady growth over the years. People have extensively relied on the use of bleach for a fairer skin tone but those come with their own set of challenges such as burns. 

More recently alternatives like glutathione and hydroquinone have gained prominence in skin treatment regimes to achieve a “brighter and a lighter” skin. While glutathione is an antioxidant produced by the liver and is involved in many body processes, hydroquinone is a chemical used to treat skin pigmentation. 

Products with these ingredients have been endorsed by celebrities and social media influencers, with many terming glutathione as a “magic” nutrient or a “wonder drug”. It is claimed to inhibit melanin production and prevent the formation of dark spots, while some claim that it also helps remove toxic and heavy metals from the body.

So, let’s understand the science behind these two products and whether there is enough evidence to support the claims made about them. 

Bizarre social media trend or a promising move?

There are several videos and posts on social media that promote glutathione treatment for skin whitening. 

For instance: A post on TikTok uploaded on May 28, 2024, with nearly 11.8 million views, where CEO & brand owner Jonah Sison-Ramos introduced S-Acetyl glutathione and claimed that it’s the most effective form of glutathione.

Another video on the platform uploaded by one Dr. Eric Berg, a chiropractor with millions of followers who has been called out for making unsupported claims, calls glutathione the “mother of all antioxidants”. He also explains how it helps the body get rid of poisons and oxidation from heavy metals. TikTok also hosts videos showing the transition from pigmented skin to a flawless and fair skin. 

We also found videos on YouTube which talk about injecting glutathione for skin whitening. 

Screenshot of posts on TikTok and YouTube. (Source: TikTok/YouTube/Screenshots)

Glutathione supplements are also being promoted on Facebook and are readily available on Amazon and Google marketplace. They are sold as SkinCeuticals and nutraceuticals.

Pills with glutathione available online in India. (Source: Google)

Several celebrities like Indian actor Soha Ali Khan and American actor Gwyneth Paltrow have also endorsed the ingredient.

While glutathione pills and injections are selling fast and showing promising results, they are approved only as dietary supplements in the U.S.. In India, Central Drugs Standard Control Organisation (CDSCO) has approved glutathione injections-600 ml (at listing 804) for the treatment of alcoholic liver diseases like alcoholic fatty liver, alcoholic liver fibrosis, alcoholic liver cirrhosis, and hepatitis.

In the Philippines, glutathione has been approved for the prevention of chemotherapy-associated nerve damage. However, the Food and Drug Administration (FDA) of the country has warned the public about the dangers associated with the use of injectable lightening agents such as glutathione such as the toxic effects on the liver, kidneys, and nervous system. In 2023, the Philippine Dermatological Society also issued a warning against the use of glutathione as a skin-whitening agent. 

Speaking to Logically Facts, Dr. D.M. Mahajan, a dermatologist at Apollo Hospitals in New Delhi, said, “Using medications for non-approved purposes, known as ‘off-label’ use, carries potential risks. The regulatory approval of glutathione for liver diseases in India does not make it safe or appropriate for skin-lightening.” 

Dr. Mahajan underscored that while some studies suggest that glutathione can reduce melanin synthesis, which could potentially help with skin whitening, the scientific evidence to support this is limited and conflicting. 

There is inadequate safety data on the use of glutathione as a skin-whitening agent. In 2019, USFDA also documented adverse events regarding seven patients who received intravenous injections containing L-glutathione. The patients experienced nausea, vomiting, lightheadedness, chills, body aches, and sneezing.  

A 2018 paper published in a peer-reviewed journal ‘Dermatology Practical & Conceptual’  explored the potential benefits of glutathione and stated, “There is little convincing evidence in favor of glutathione as a therapy for hyperpigmentation at the present time, and there are many unresolved controversies that surround its use.”

The paper evaluated two clinical trials that studied oral consumption of glutathione and highlighted its major limitations. These trials had small sample size, short study period, and shorter follow ups.

Answering questions about glutathione for UCLA Health's (University of California, Los Angeles) series, Dr. Robert Ashley highlighted that there is no good study on the use of glutathione in healthy people. “Less is known about glutathione’s use as a general supplement, although it has been evaluated by the FDA for AIDS-related weight loss,” he said. 

On examining the quantity of glutathione in the supplements, we found that it ranged from 300 mg to 500 mg. Commenting on the permissible levels, Dr. Mahajan said, “Since glutathione is not approved for skin lightening, there are no established safe limits.” He also highlighted that the “safety profile for long-term use, especially at high doses, remains unclear.” He added that the possible side-effects include abdominal pain and problems related to kidney and liver. 

If not glutathione, do other skin-lightening products work?

Skin-lightening products and treatments work on the concept of reducing the production of melanin, the pigment that gives color to the skin. This is also done with the help of topical creams, chemical peels, laser treatments, or oral medications. 

While skin-lightening products are a big rage, the US FDA issued warnings to many companies and products over the last few years. In 2022, the FDA issued warning letters to 12 companies for selling over-the-counter (OTC) skin-lightening products containing hydroquinone that do not meet the requirements to be legally sold as OTC drugs. 

Between 2019 and 2022, the FDA recalled 22 skin whitening creams from Japan, Pakistan, and Mexico as the products were found to contain mercury or hydroquinone. It also issued an advisory with the name SkinFacts that educates about mercury and hydroquinone products and how they can be harmful to kidneys.

Skin-lightening products containing 2 percent hydroquinone are approved for over-the-counter sales and the use of mercury in skin-lightening products is banned. The World Health Organization (WHO) has also condemned the sale of skin-lightening products and highlighted their significant risks to human health and the environment. 

In 2020, the Indian Ministry of Health and Family Welfare, under the Drugs and Magic Remedies Act proposed an amendment to ban the promotion of skin-lightening products. In the United States, the FDA has banned mercury in cosmetic products at levels >1 ppm since 1973. In 2019,  the United States and the Philippines, and in 2021 Ghana, publicly condemned the use of glutathione injections and issued advisory warnings against its use.

Dr. Mahajan explains that “skin color is primarily determined by genetics and melanin production. While specific treatments may temporarily lighten skin tone or reduce hyperpigmentation, fundamentally changing one’s skin color is neither easily achievable nor necessarily safe.” 

However, the reliance on these products is also increasing due to societal acceptance. 

Is skin color a barrier to accessing health and social status?

According to Penn State University research on the evolution of skin color, “We inherit our skin color from our ancestors, and so it is obviously a trait that is tied to our biology and genetics.” While skin color is based majorly on genetics, there is discrimination based on it even when it comes to healthcare. 

Black community members are often not taken seriously by health professionals. A 2022 study found that “dark-skin Black Americans do not derive the same health benefits from higher SES (socioeconomic status) as their White or light-skin Black peers.” Another study highlighted how black patients are less likely to get specific treatments than white people. 

There is also a deep-rooted belief that white skin color is synonymous with beauty. In India, marriage proposals are made based on skin color. 

A Matrimonial advertisement searching for a fair and beautiful bride. (Source: Pinterest)

According to WHO, skin bleaching is a widespread practice both in African and Asian nations and has its roots in colonization and the slave trade. 

A Harvard report by Dove Beauty explored the impact and cost of beauty ideals through the dual pathways of body dissatisfaction and appearance-based discrimination. According to the report, 66 million people were affected by appearance-based discrimination in 2019, of which 27 million faced skin tone discrimination.