Ophelia E Dadzie , consultant dermatologist and dermatopathologist Departments of dermatology and histopathology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK opheliadadzie{at}nhs.net 
 
 UK regulators must warn against this potentially dangerous practice 
 
 Skin bleaching is the misuse of skin lightening agents to lighten constitutive skin colour.1 It is a purely cosmetic procedure which should be distinguished from the use of skin lightening agents by physicians to treat pigmentary disorders. 
 
 Skin bleaching is a global phenomenon practised by a range of people living in communities in Africa, North and South America, Asia, the Middle East, and Europe.1 Agents used for skin bleaching include hydroquinone, topical steroids, mercurials, kojic acid, and sometimes products such as battery fluid and cement.1 
 
 Potential adverse effects associated with this practice include irritant and allergic contact dermatitis, exogenous ochronosis, infections, and systemic problems such as hypertension, diabetes mellitus, and renal disease.1 In light of this, public health campaigns around the world have focused on educating communities about the dangers of skin bleaching. 
 
 Despite these efforts, anecdotal … ||||| Brittany Burhop Fallon , Senior Editor | August 09, 2017 
 
 In the U.S. skin care industry, the "brightening" category is a major one. It seems like everyone has a desire to get rid of dullness and discoloration, and as a result, there's been a huge boost in these products on the market. Everything from serums and creams to supplements and laser treatments are touted as "skin brighteners," but in other parts of the world, particularly Asia, there's even more. 
 
 In regard to Asian beauty trends, we're familiar with the 10-step skin care regimens and K-beauty surge we've seen throughout recent years, but there's another, more "serious" trend, you may not be well-versed on: skin whitening, and people will do just about anything to achieve it. 
 
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 "In every culture, there is a cultural and societal trend toward altering skin color," says New York dermatologist Melissa Kanchanapoomi Levin, MD. "In many Western societies, individuals seek to tan their skin, as this is associated with a 'healthy glow' or having a lifestyle that consists of traveling and outdoor activities. In some Asian and African countries, darker-skinned individuals are in search of whitening or lightening agents. And in certain Asian countries, a lighter skin tone is a desirable trait for some, as it is associated with wealth and higher societal class." 
 
 To feed this large societal demand for skin-lightening agents in Asia, Dr. Levin says many of the same treatment options that we favor in the U.S. are used, such as topical medications including hydroquinone, kojic acid, vitamin C, glycolic acid, arbutin, glycolic acid and retinoids. However, when the desired whitening supersedes what these topicals can deliver, there's another treatment Asian women are turning to: injections of glutathione (GSH). "Glutathione is a naturally occurring antioxidant that plays a key role in important physiological processes such as neutralizing free radicals, detoxification and cellular breakdown of proteins," explains Dr. Levin. "It was discovered to have antimelanogenic (or anti-pigment) properties through multiple pathways, but only in vitro, meaning in the petri dish, not in clinical trials." 
 
 The countries where this injection (it's performed intravenously; typically in the arm) is most prevalent are Vietnam, the Philippines and India—it's actually illegal in Thailand, but oral and topical forms of the medication are available as alternatives and considered popular skin-lightening options in other countries as well, such as Malaysia, China, Korea and Taiwan. However, Dr. Levin says it is hypothesized that the intravenous form is more bioavailable than the oral form (meaning your body can actually use what is injected), but there are also no studies to support this. "Most importantly, the data on safety is very limited," she adds. 
 
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 While recently speaking to a Vietnamese woman, she told me women in her country are paying upward of $1,000 to have the GSH injection, which claims to "whiten" skin as little as two to three weeks. Dr. Levin says she is unable to comment on the cost of the medication, as she is unaware of the GSH manufacturing process and why it is so expensive. "What I can say is this: In Asia, the skin-lightening cosmetic market is astronomical. Companies that manufacture these products and charge high prices for them are able to make unverified claims because these preparations are commonly labeled under a hybrid category between pharmaceutical and cosmetic products. This allows the manufacturers to evade regulations, which makes the potential risks and efficacy difficult to be evaluated." 
 
 So how come something like this doesn't exist in the U.S., especially when, according to the International Society of Aesthetic Plastic Surgery, more cosmetic injections are performed per year in the U.S. than any other country? "While intravenous glutathione has been used for many years, there actually isn’t a single clinical trial demonstrating that this actually works!" says Dr. Levin. "The three randomized controlled studies that were performed evaluated topical and oral preparations, not intravenous. The most commonly recommended treatment course is 600mg–1200mg injected once to twice weekly. Keep in mind there are NO clear guidelines regarding the duration of the treatment or whether this is actually the right dosing." 
 
 "Additionally, in the Philippines, where this medication is widely used, the FDA of Philippines issued a warning regarding the safety of glutathione injections, reporting adverse reactions including life-threatening skin rashes, thyroid dysfunction, kidney failure, severe abdominal pain, infection, and even death. It is currently unknown whether these side effects are due to the drug itself or additives within the injection vials. Other potential adverse effects of intravenous glutathione is patchy skin lightening or discoloration, stomach ulcers, lightening of hair color, and concern (but not yet proven) for increased risk of melanoma." 
 
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 Regardless of whether it actually gives women brighter, prettier skin, GSH injections can have serious side effects. As Dr. Levin puts it: "Until we have well-conducted, long-term, randomized controlled studies to ensure the safety and efficacy of these treatments, intravenous glutathione remains unproven as a skin-lightening agent." ||||| Subscribe: FDA Consumer Health Information 
 
 Consumers need to beware of products to lighten or whiten their complexion. These products, which include both injectable skin whitening and skin bleaching products, are potentially unsafe and ineffective, and might contain unknown harmful ingredients or contaminants. 
 
 Injectable skin whitening products are marketed for injection into a vein or muscle or under the skin. They are sold online and in some retail outlets and health spas. They often promise to lighten the skin, correct uneven skin tone, and reduce blemishes. Some products even claim to treat conditions such as liver disorders and Parkinson’s disease. 
 
 Although the average consumer might not assume so, these products are unapproved new drugs whose sales are not condoned by the U.S. Food and Drug Administration (FDA). The FDA has not approved any injectable drugs for skin whitening or lightening. 
 
 “These products pose a potentially significant safety risk to consumers. You’re essentially injecting an unknown substance into your body—you don’t know what it contains or how it was made,” says In Kim, a pharmacist at the FDA. 
 
 Beyond the potential harm from the product itself, improper or unsafe injection practices may transmit disease, cause infection, and result in serious injury. 
 
 On September 25, 2017, a federal judge ordered the New Jersey company, Flawless Beauty LLC, to halt sales and recall some of its products because they are unapproved new drugs that may be unsafe, putting consumers at risk. Flawless sold skin whitening and other products under the Relumins, Tatiomax, TP Drug Laboratories, Laennec, Saluta, Tationil, and Laroscorbine brands, among others. 
 
 “We have noticed a number of companies marketing injectable products for skin whitening online and are concerned that these products and their ingredients may cause serious harm to consumers,” Kim says. 
 
 The products sold by Flawless contain ingredients, including glutathione, vitamin C, collagen and even human placenta. 
 
 “In general, consumers should be cautious of any products marketed online with unproven claims about their safety and effectiveness,” Kim says. “Consumers also should consult with their health care practitioner before deciding to use any new drug product.” 
 
 What You Should Do 
 
 If you have used any injectable products for skin lightening or whitening and are experiencing side effects, consult a doctor as soon as possible. You or your doctor can also report an illness or injury you believe to be related to the use of these products by calling 1-800-FDA-1088 or visiting FDA online. 
 
 If you have questions about particular skin conditions, consult a health care professional. There are FDA-approved topical drug products to treat certain skin conditions, for example, hyperpigmentation (which causes the skin to darken) and melasma (which causes patches on the face). 
 
 Unlike the unapproved injectable skin whitening drug products, FDA-approved drugs have been determined by FDA to be safe and effective for their intended use. In addition, facilities where the approved products are made are generally subject to FDA inspection and must comply with FDA regulations and good manufacturing practices. 
 
 This article appears on the FDA’s Consumer Updates page, which features the latest on all FDA-regulated products. 
 
 Updated: April 19, 2018 
 
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– Health experts want consumers to be wary of an intravenous treatment that claims to erase skin blemishes and lighten skin tone in a safe alternative to dangerous skin bleaching creams. Intravenous treatments gaining popularity in Asia, the UK, and the US involve weekly or twice-weekly doses of glutathione, the naturally occurring antioxidant which is believed to reduce melanin production in the body, reports the New York Times. But while oral and topical glutathione treatments have undergone study, experts say no major studies have explored the possible dangers of IV glutathione treatment, which can go for $150 to $400 per dose, with some spas recommending as many as 30 doses to be repeated every few months. That's despite the FDA stating injectable skin-lightening products "are potentially unsafe and ineffective, and might contain unknown harmful ingredients or contaminants." An editorial in the BMJ suggests IV glutathione treatments may also pose a cancer risk, while the Philippine government has linked the practice to skin disorders, thyroid dysfunction, kidney dysfunction, and even death, per NewBeauty. Reports of side effects are lacking in the US, where treatments are less frequent than in the Philippines, involve smaller doses, and are administered by doctors and nurses. But "it's probably not a good idea to use something when you don't know all the potential side effects," a dermatologist tells the Times. (This country has banned skin whiteners.)