Why experts warn against intravenous use of ‘wonder’ drug Glutathione

With Season 2 of 'Made in Heaven' kickstarting the debate around Glutathione, a drug that is said to lighten skin tone, doctors and researchers are agreeing that the topical use of the drug has been in use since quite sometime now. Much before the series went on air, glutathione has been in rampant use among those obsessed with fairness. That it led to a number of research papers in the academia is a proof of this as also aggressive marketing by pharma-cosmeceutical companies since the past few years has brought glutathione in the centre of debate.

Glutathione has antimelanogenic properties which has led to physicians frequently administering it as a “wonder” drug for skin lightening and treatment of hyperpigmentation, especially in those with darker skin tones. Aggressive marketing and capitalization of pharma-cosmeceutical companies has led to a surge in this 'trend.'

However, the unbridled and prodigal use of it, say experts, especially as a parenteral formulation, seems unjustified, "given the lacunae in our knowledge about its antimelanogenic potential, limited clinical evidence favoring its role in skin lightening, and the statutory ban/advisory issued by certain federal agencies."

Glutathione is available in topical, oral and injectable formulations. While as per researchers, topical (that is creams and lotions which are applied on the skin) and oral forms are safe, the safety and efficacy of the intravenous forms have not yet been proven.

In 2019, in the 'Journal of cosmetic dermatology,' a group of researchers studied the clinical effects of glutathione on skin color and related skin conditions. They evaluated the effect of glutathione on skin using four case studies of healthy individuals - three of them consumed it in oral form while one applied it as a cream on the skin.

The study found that 'both oral glutathione with the dosage of 500 mg/day and the cream could brighten skin color in sun-exposed area measured by skin melanin index. But there was no significant difference observed in the reduction in skin melanin index in sun-protected areas of the skin. “Some adverse events were reported but they were of a non-serious nature,” the report observed.

A year later, in 2020, researchers from the University of Allahabad published their report in the International Journal of Research in Dermatology stating that “Currently, there is only a little considerable evidence in favor of glutathione as a therapy for hyperpigmentation, and there are many unsolved controversies that surround its use. Although the safety of topical and oral GSH proved to be good, their efficacy especially long-term remains questionable.”

Again, as per researchers from Patna Medical College, there is little convincing evidence in favour of glutathione as a therapy for hyperpigmentation at the present time.

"The trials available to date that have evaluated the role of glutathione in skin lightening administered through different modes have numerous limitations. Although the safety of topical and oral GSH seems to be good, their efficacy (especially long-term) remains questionable. More evidence in the form of high quality trials with better study design, larger sample size, and long-term follow-up is vital, before our patients are subjected to glutathione-based treatments," reads the report by researchers as published on the NIH website (an official website of the US government.)

According to Dr Smriti Naswa Singh, consultant dermatologist and cosmetic dermatologist practicing at Fortis Hospital in Mulund, Mumbai, "in the past few years I have observed that patients have been demanding prescription of glutathione, and asking questions whether intravenous is more effective than oral or cream/topical formulation. The need for quicker results for ‘social emergencies’ like weddings etc. makes people come up with such demands to doctors. Social media has definitely increased partial awareness towards this. However, it must be noted that glutathione is not US FDA approved and Phillippines FDA has issued a warning against it."

As per dermatologists, Glutathione works by decreasing the melanin production in the skin. It is effective for short term use in those with hyperpigmented conditions like melasma, facial melanosis and so on. Long term use of glutathione via IV injections should be highly discouraged, say doctors. IV glutathione in Philippines is associated with kidney, liver dysfunction, and stevens-johnson/toxic epidermal necrolysis (SJ/TEN ) like drug reactions. "Strict avoidance of over the counter usage of glutathione is warranted. and patients should know that once they stop the glutathione, their original color will come back," says Dr Singh.