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Brown women have spent decades trying to rub whiteness into our skin, whether it was the ubtan and haldi mix made in our kitchens or toxic bleach creams from the corner store like Fair & Lovely and Stilman’s. Now, the multibillion-dollar skin bleaching industry has found a  new way to sell whiteness, this time injected directly into our veins.

According to practitioners who administer these so-called ‘skin whitening injections’, skin colour can lighten as a result of an antioxidant called glutathione, which is believed to suppress melanin production when administered in high doses.

Glutathione as a compound is neither new nor exotic. Your body makes it daily, for free, as part of its routine defence against cellular damage, and while a healthy body can replenish glutathione on its own, it’s  also found in foods such as asparagus, avocado, spinach and cucumbers.

Today, injectable glutathione is a big business globally.

Houston-based pharmacist Anum Shaikh, who has dispensed glutathione injections for patients needing to boost immunity and overall health, says that in the United States glutathione injections are used primarily for overall wellbeing rather than skin whitening. But in South Asia, Southeast Asia and most African countries, what began as supportive therapy in cancer and liver medicine has become one of the most popular ways to become a few shades paler.

In fact, while reporting this piece, Instagram showed me no less than 30 Pakistani clinics selling “gluta drips” with captions promising more energy, stronger immunity, and a detoxed liver. Strip away the vocabulary of self-care and what we are really being sold is the oldest offer in the Asian beauty economy: lighter skin.

According to Lahore-based dermatologist Dr Amna Ahmar, glutathione is thought to lighten skin by blocking tyrosinase, the enzyme that controls how much melanin (the pigment that gives skin its colour) your cells produce, and by nudging that production away from darker pigment towards a lighter pigment.

At a reputable clinic in Pakistan, a single session of intravenous glutathione will set you back around Rs25,000 — the monthly salary for many domestic workers. Patients typically commit to once or twice a week for 10 to 12 sessions followed by indefinite “maintenance” sessions because results are not permanent and fade within months.

“Someone who is committing to spending Rs80,000 a month needs to know that this isn’t something that’s going to transform them,” says Dr Ahmar.

“When a patient comes to me, before jumping to injections, I look for the real problem. For instance, if a patient has PCOS and insulin resistance causing acne or melasma, I treat that. Fix the dermatological issue first. If you have extra to spend after that, add the IV. It’s like sugar, the more you add the sweeter the benefits.”

But here’s the quiet absurdity at the heart of the whole business. People are paying, week after week, to inject a drug that not only lacks approval from any health authority in the world but has never been proven to lighten skin.

According to Houston-based dermatologist Dr Sana Zahiruddin, only a few studies suggest glutathione may produce a modest reduction in skin pigmentation in some people.

“These studies are small and their results are inconsistent,” cautions Dr Zahiruddin. “If someone does notice a difference, it is usually subtle and not everyone will respond.”

Interestingly, one of those studies is Pakistani.

Ten years ago, a team of Multan-based doctors tested glutathione on 25 women, injecting 1,200mg twice a week for six weeks and comparing them against 25 women given only saline. The results were sobering. Only about a third of the women’s skin lightened at all — statistically no better than the saline group — and even those results faded, with only one patient still showing any results six months later.

Most alarming was the harm, with every single woman in the glutathione group suffering side effects, including signs of liver damage. One woman went into anaphylactic shock, a severe and potentially fatal allergic reaction.

“The Pakistani study and the more recent studies do not provide convincing evidence that intravenous glutathione is an effective or safe skin lightening treatment. At best, these studies suggest that a minority of patients may experience a modest and temporary change. At the same time, they raise meaningful safety concerns,” says Dr Zahiruddin. “I would not recommend intravenous glutathione for cosmetic skin lightening based on the evidence currently available.”

Islamabad-based aesthetic physician Dr Taskeen Iqbal agrees.

“The truth is that the results from glutathione injections will be gradual and modest,” she says. “If you see a dramatic before and after photo, that is editing, not biology because skin cannot change that far or that drastically from a drip. But it gets marketed as lightening or whitening because that word sells.”

‘Brighter’ skin

The use of glutathione is regulated in the country by the Drug Regulatory Authority of Pakistan (DRAP), which has in at least one instance approved oral glutathione as a nutritional supplement and injectable glutathione to treat the side effects of chemotherapy.

“An aesthetics clinic providing glutathione drips is, in practice, answerable to almost no one,” warns Dr Iqbal. “In Pakistan, enforcement is thin on the ground, it is close to a wild west. And, in the US where a vial can be ordered after a 15-minute virtual consultation, what that tells me is that looseness is not a Pakistani failing alone. Even tightly regulated markets have wide gaps around this treatment. Until the rules catch up, the burden of safety falls unfairly on the patient to choose well.”

While Pakistani medical authorities have thus far been silent on the off-label use of glutathione injectables for skin lightening, governments elsewhere have been warning against them for years.

In the Philippines, where skin whitening injections have been wildly popular for many years, the dermatological society has repeatedly warned that there is no scientific proof that glutathione whitens skin. In 2024, the health secretary warned against the use of skin whitening injectables following the death of a 39-year-old woman from complications after using intravenous glutathione.

Similarly, the Saudi Food and Drug Authority has warned against unregistered skin-whitening injections that contain glutathione. In Malaysia, glutathione is named in the country’s Negative List of the Drug Registration Guidance Document and has not been approved for aesthetic use by its National Pharmaceutical Regulatory Agency. In Nigeria and Ghana, health ministries have issued warnings on the risks of glutathione, specifically flagging certain cancer and kidney disease risks.

In India, where the injections have surged in popularity, a doctor recently went viral when he accused clinics of false advertisements, claiming they posted dramatic before and after photos that are  “90 per cent lighting, filters and thora sa (a little) Photoshop”.

Then, there is South Africa, which has fought hard against skin whitening products in general. In 1975, the government banned mercury-laden cosmetics and, in the 1990s, South Africa became one of the first countries in the world to restrict the sale of skin-lightening creams containing harmful ingredients. A study published in the South African Medical Journal highlighted safety concerns surrounding the use of glutathione.

In the United States, as early as 1889, Black and eastern European women were using toxic skin whitening products in the hopes of accessing the cultural and economic privileges whiteness accrues.

More recently, in 2020, the Black Lives Matter movement forced a global racial reckoning resulting in skincare giants such as Nivea, Pond’s, Unilever and L’Oréal pledging to stop using words like “whitening” and “fairness” to market their products. That’s also how Fair & Lovely got its rebrand.

But because the market demand never went away, despite dropping “fair,” “white” and “light” from packaging labels, these brands still market the same product using softer descriptors like “glow,” “brighten” and “radiant”.

All this necessarily stokes a debate on the toxic yet completely accepted culture of colourism amongst South Asians.

Whereas racism sorts people by race, colourism sorts people by the shade of their skin. And where racism manifests as prejudicial behaviour aimed towards another community, colourism turns inward, with prejudicial behaviour towards one’s own community.

If you are a brown girl who is a shade darker than white paint, you’ve experienced colourism in some form — from ‘innocent’ family remarks to the not-so-innocent, unsolicited comments by random aunties.

Colourism is the reason a darker-skinned woman and a lighter-skinned woman from the same community or with the same credentials or even from the same family can be treated differently over nothing more than the depth of their skin tone. Colourism is the reason Pakistan’s TV and film industry often casts light-skinned actors as the good, more desirable lead character while their browner counterparts are the villains or sidekicks.

Indeed, every expert I interviewed for this story had, frankly, heartbreaking examples of patients — from housewives to PhD candidates — wanting to whiten their skin, with some hoping it would lead to better rishtas, others readying themselves for their wedding and some hoping to improve their economic prospects.

And, while the demand for glutathione injections skews heavily female, dermatologists — including the ones interviewed for this story — report an increasing number of men pursuing the treatment, although women remain the primary market for skin-whitening services.

According to these physicians, some patients will be direct about what they want, even bringing in photos of Pakistani celebrities they suspect have used whitening injections. Others will skirt around the issue, using the language of self-care and emphasising they don’t want to “whiten” per se and are instead just there to enhance their “glow”.

But, as Dr Zahiruddin points out, unlike in the cosmetic world, in the field of dermatology ‘brightening’ and ‘lightening’ are two very different things.

“Brightening, in dermatology, usually means improving an uneven skin tone, fading dark spots, to give the skin a healthier, more even appearance. But in the cosmetic marketplace, the terms brightening, glowing, and radiance are often used to market products that are really intended to lighten a person’s overall skin tone,” she points out.

Really, no matter how we dress up the demand, one thing is for sure: our colonial hangover has left us irredeemably convinced that brown skin is a problem to correct. Indeed, this article is not really a story about a skin-whitening injection. It is a story about a sickness spread by our former colonial masters, then maintained by a multibillion-dollar industry that has taught generations of brown women that our worth increases the closer we are to being ‘white’.

The belief is old — injectable glutathione is just the latest delivery system.

Art by Mohsin Alam