Health Tips

Skin whitening is a huge industry as both men and women are progressively getting more conscious of their outlook. Although many manufacturers claim that their products can whiten skin despite little scientific evidence, none of them are as controversial as skin whitening injections. In order to stop such sham, he Ministry of Health, Malaysia even went as far as publishing a report on Vitamin C injections.

Myths and Facts

There are mainly three injection products purported to have whitening properties:

• Vitamin C (Ascorbic Acid) is the most popular of the three injections. There are scientific studies to suggest that vitamin C might have some skin lightening effect, particularly in skin depigmentation. Melanin is a protective skin-darkening pigment produced by a type of cell called melanocytes and vitamin C is said to interrupt the production of melanin in these cells. Another purported function of vitamin C on the skin is that it promotes the production of collagen. This is true. It is an important factor required to produce collagen. However, there is no concrete evidence to show that vitamin C actually lightens the skin tone or whitens skin colour. Searches done in major health research databases yielded no results. Vitamin C as a skin whitening agent is a definite myth. In terms of safety, vitamin C is known to be safe in humans up to doses of 10g daily. 

• Glutathione is another popular product used as an injection for skin whitening. It is a strong anti-oxidant that is toxic to melanocytes hence by reducing these cells, it reduces melanin production. Since glutathione is not well absorbed when taken orally, it is preferred to be given in the form of an injection. There are a few studies that have shown positive results with glutathione in whitening. However, these studies used oral or topical (applied on skin) forms of glutathione, not injections. Furthermore, these studies were rather small-scaled with short duration and design flaws were apparent. In view of conflicting data between poor oral absorption with the poorly designed studies showing positive results, the claim that glutathione whitens skin does not hold water until more well-designed studies show otherwise. Glutathione injections is widely used medically in patients with liver disease and data studying these patients revealed good safety profile. 

• Tranexamic acid is used medically to promote blood clotting. The discovery of its skin whitening properties was a case of scientific serendipity. Researchers studying the use of tranexamic acid in treatment of bleeding in brain noted that their patients became fairer. It works by blocking the synthesis of melanin when exposed to UV (ultraviolet) rays. Numerous studies have shown reduced pigmentation and lightening of skin tone with the use of tranexamic acid. However, these studies are still not large enough and more robust studies would be required to justify its cosmetic use and safety. Tranexamic acid is the most promising of the three drugs to deliver whitening effects, but it also has the most potential for unwanted effects which include nausea, vomiting, palpitations and reduced menses in women. There’s also a possibility of increased risks of stroke and heart attacks because it increases the tendency of blood clot formation. 

Dubious Sources

With the exception of tranexamic acid, vitamin C and glutathione injections are not licensed in Malaysia which means that the products available here are generally smuggled into Malaysia. This makes the sources of the products doubtful. Furthermore, there are strict storage conditions for medical products, such as temperature and exposure to sunlight, which are also not guaranteed in smuggled products. They may have been through harsh weather and storage conditions which may have compromised their quality and safety.

*Note: The following paragraph is based purely on the author’s personal professional opinion rather than evidence.

As a pharmacist who has been in practice for over 10 years, I have encountered patients who brought the vials/ampoules of vitamin C and glutathione injections to me for verification. The quality of the vials appeared to be substandard while the labels were dodgy. The boxes which my patients brought in varied in sizes and printing, suggesting that these boxes came from various sources rather than a single manufacturer.

*end of personal opinion.

Safety Issues

When sources are doubtful, the quality of medications cannot be verified. Manufacturing of medications is governed under strict laws as laid out under GMP (Good Manufacturing Practice) ensuring the quality and safety of medications. This is especially important in manufacturing injections. Because injections are introduced directly into blood, any particles within the solution may block blood flow and cause devastating consequences. Another danger is the possibility of bacterial contamination during the manufacturing process. Injecting bacteria into the bloodstream may cause a condition called sepsis where a person’s blood is infected. Sepsis has a very high death rate.

Lastly, many places offering these injections are not medically trained. This includes beauty parlours and other doubtful establishments. When injecting medications into blood, proper procedures and techniques need to be followed to prevent infection and sepsis. It is a huge risk to take when receiving injections from non-medical personnel.

Professional Advice

There is a huge demand for skin whitening in the current world. However, there are many myths mixed with truths making it very difficult to differentiate and many parties are taking advantage of this. It is best if one seeks professional advice from their doctor or pharmacist before taking certain products.

References:

1. Telang PS. Vitamin C in dermatology. Indian Dermatol Online J. 2013;4(2):143-6.
2. Arjinpathana N, Asawanonda P. Glutathione as an oral whitening agent: a randomized, double-blind, placebo-controlled study. J Dermatolog Treat 2012;23:97-102.
3. Handog EB, Datuin MS, Singzon IA. An open-label, single-arm trial of the safety and efficacy of a novel preparation of glutathione as a skin-lightening agent in Filipino women. Int J Dermatol 2016;55:153-7.
4. Watanabe F, Hashizume E, Chan GP, Kamimura A. Skinwhitening and skin-condition-improving effects of topical oxidized glutathione: a double-blind and placebo-controlled
5. clinical trial in healthy women. Clin Cosmet Investig Dermatol 2014;7:267-74.
6. Malathi M, Thappa D. Systemic skin whitening/lightening agents: What is the evidence?. Indian J Dermatol Venereol Leprol. 2013;79(6):842-846.
7. Sonthalia S, Daulatabad D, Sarkar R. Glutathione as a skin whitening agent: Facts, myths, evidence and controversies. Indian J Dermatol Venereol Leprol. 2016;82(3):262-272.
8. George A. Tranexamic acid: An emerging depigmenting agent. Pigment International. 2016;3(2):66-71.
9. Nadiah H, Hannah M, Lee K, Mohd Jofrry S, Long C. Use of tranexamic acid for skin whitening and melasma therapy: A product review. Archives of Pharmacy Practice. 2016;7(6):43-47.
10. Health Technology Assessment Section Medical Development Division. Vitamin C Injection For Cosmetic. Putrajaya: Ministry Of Health Malaysia; 2012.

Image credit:

1. http://www.latestlifestyles.com/wp-content/uploads/2013/04/natural-face-whitening-tips.jpg
2. https://bit.ly/2LCRQib
3. https://image1.jdomni.in/product/17022018/71/69/89/FF5F1B4737663621B017607483_1518835996896_450X450.jpeg
4. https://cdn.theculturetrip.com/wp-content/uploads/2017/03/shutterstock_524224117-irina-bg-650x490.jpg

In collaboration with Dosing Health.

Written by

Pou Wee Gan