A New Skin Lightening Procedure Is Short on Evidence

Samantha Peters is trading in her foundation and concealer for an IV. For years, she’s had a daily makeup routine to cover dark blotches on her face and the discoloration and scarring on her arms that won’t go away — a common problem for those with darker skin tones.

Now she’s hoping a new treatment, intravenous glutathione, will accomplish what makeup and skin bleaching creams could not: an even, lighter skin tone.

Glutathione is an antioxidant naturally found in human cells that neutralizes free radicals, boosts the immune system and detoxifies the body. It can also cause skin lightening by converting melanin to a lighter color and deactivating the enzyme tyrosinase, which helps produce the pigment.

Intravenous glutathione treatments, like those Ms. Peters receives, are meant to increase those natural effects, diminishing scars and blotches while lightening skin color over all.

“It makes me glow,” said Ms. Peters, 37. “I’ve been complimented that my skin looks lighter already.”

While studies have shown oral and topical glutathione are safe for dietary supplementation and skin lightening, there have been no rigorous, large-scale studies on the use of an intravenous form for skin lightening or on its long-term side effects. Most of the evidence glutathione proponents point to comes from individual case reports or anecdotal experiences.

But a growing number of women around the world are turning to intravenous glutathione to reduce blemishes or for skin lightening. For many, like Ms. Peters, it’s a combination of both.

The trend is particularly evident in parts of Asia, where lighter skin is often considered more desirable and can indicate higher social status, but it is also cropping up among certain communities in Britain and the United States.

Bleaching creams, though popular for decades, come with a host of dangers, including chemical burns and mercury poisoning. Glutathione is promoted as a safe alternative, but there’s no clear evidence to support that claim.

“There’s a lot we don’t know about it. That’s the biggest problem,” said Dr. Fran E. Cook-Bolden, a dermatologist at Skin Specialty Dermatology in Midtown Manhattan and co-author of “Beautiful Skin of Color: A Comprehensive Guide to Asian, Olive and Dark Skin.” “That doesn’t mean it’s necessarily bad,” she added, but “it’s probably not a good idea to use something when you don’t know all the potential side effects.”

In the Philippines, where intravenous glutathione treatments are very popular in spas and beauty salons, there have been reports of serious skin disorders, thyroid function impairment and kidney dysfunction. The Philippine food and drug agency has condemned the use of intravenous glutathione for skin lightening, noting that the treatment is approved only for certain medical conditions. The agency has penalized several spas providing the service, but because it does not license beauty establishments, it is difficult to monitor them, said Dr. Benjamin G. Co, director of the agency’s drug regulation division. The treatments remain as popular as ever, he said.

The practice is less common in the United States, but dermatologists and aestheticians say demand is slowly growing. The Food and Drug Administration issued an advisory on the dangers of unregulated injectable skin-lightening agents sold online and in stores, but it hasn’t taken a stance on treatments provided by medical professionals.

Most experts say there haven’t been reports in the United States of serious side effects. Rather, it’s the lack of evidence-based guidelines on dosage and the long-term effects of glutathione that raises concern.

Photo

Lakeyshya Brown, left, prepared the glutathione treatment for Ms. Peters. “You get more side effects from Tylenol and Motrin than you get from this,” said Ms. Brown, a registered nurse. CreditNicole Craine for The New York Times

“Glutathione predominantly is being used internationally,” said Dr. Seemal R. Desai, a dermatologist in Texas and president of the Skin of Color Society, which raises awareness about the special dermatologic needs of different skin tones. “But it’s on the rise. We’re seeing more of it, even in our American population.”

Lavish Laser, the medical spa in Midtown Manhattan where Ms. Peters gets her treatments, sees clients of various backgrounds. Leslie Nesbitt, one of the founding partners, said many African-American clients come in after disappointing experiments with skin bleaching that result in burns and scars. East Asians often want to reduce sun damage, and clients of South Asian descent often want to be a shade lighter. “One Indian woman wanted to get whiter before her wedding,” Ms. Nesbitt said.

The treatment has been popular, she said, attracting six to 10 clients a week, many of whom travel an hour or more to the medical spa since the treatment is not widely available. A handful of medical spas and wellness centers offer the service in New York and other major cities, but patients posting in online forums say it is difficult to find providers.

In Atlanta, Dr. Ava Bell-Taylor said her wellness and aesthetics center, the Taylor Medical Group, sees dozens of patients a day for glutathione skin lightening. Many clients tell her they used to fly out of the country until American doctors started offering this service in the last few years.

Treatments involve anywhere from 1,500 to 4,000 milligrams of glutathione, often combined with vitamin C, administered once or twice a week. Each session can cost $150 to $400, depending on dosage and location. Some medical spas recommend 10 treatments, while others say as many as 30 could be necessary to see the desired result. IVs are administered by nurses or doctors.

Even once the skin is lightened, patients have to come back every few months for maintenance. As the glutathione levels fade, so do the effects.

In the Philippines, glutathione treatments are often delivered by people not trained in IV administration, and at higher doses with greater frequency.

Proponents of glutathione in the United States say that’s why patients there see serious side effects, while those in America don’t.

Lakeyshya Brown, a registered nurse who administers glutathione treatments at Lavish Laser, said that in other countries, the glutathione solutions might be mixed with other substances that could cause unintended side effects. It may also be delivered by aestheticians who are not trained in IVs and injections, increasing the risk that a patient could become infected or be injected with air, leading to a potentially fatal embolism.

But when glutathione is acquired from a pharmacy in the United States and administered by a medical professional, there are nearly no side effects, Ms. Brown said. “You get more side effects from Tylenol and Motrin than you get from this.”

Others say there’s not enough evidence to know that for sure.

An editorial in the British Medical Journal suggests the treatment carries a long-term risk of cancer.

While the F.D.A. has not approved any injectable drugs for skin lightening, that doesn’t bar medical professionals from using an agent like glutathione for such purposes. “Health care professionals generally may choose to prescribe or use a legally marketed human drug for an unapproved use when they judge that the unapproved use is medically appropriate,” the agency said in a statement.

Off-label use of drugs is very common in dermatology, said Dr. Desai, the Texas dermatologist. The difference is that those are typically clinically tested treatments. Dr. Desai does not administer or recommend glutathione. “The issue, to me, is that there isn’t a lot of data on it,” he said.

But the lack of certainty around the treatment’s safety doesn’t worry all patients. “There are side effects to everything,” Ms. Peters said. And since she hasn’t experienced any from her five glutathione treatments so far, she sees no reason to stop.

Source:-nytimes.

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