Pigmentation
22 June 2022
Skin bleaching creams and whitening drips- Academy Award winner, Lupita Nyong’o is celebrated for her dark skin and natural hair in a world where fairer skin is preferred in most cultures. In a powerful speech against colorism (prejudice against skin colour) in 2014, she spoke about being taunted for her dark skin and of how narrow standards of beauty affected her self esteem when she was younger. In the same speech, she also shared shared a heartening anecdote about a young fan who wrote to her to thank her for making this young fan change her mind about buying a skin bleaching cream after seeing that it was possible for Lupita, an actress with dark skin, to be successful in Hollywood.
The phenomenon of skin bleaching is a global problem with rates as high as 77% in countries like Nigeria, according to a WHO estimate1. Skin bleaching or skin lightening is highly controversial and has complex historical, economic, sociocultural, and psychosocial roots across different cultures2. Skin whitening is also a rapidly growing industry globally, with the global market for skin lightening products projected to reach USD$23 billion by 20203. This figure will represent approximately 17% of that 2020’a total projected cosmetics sales4– a big share of the cosmetic skincare pie indeed.
In Singapore, skin whitening drips and creams containing toxic chemicals are banned by the Ministry of Health. However, this has not deterred consumers from seeking whitening drips overseas or purchasing skin bleaching creams online. This review will look at the science and safety (or lack thereof) of skin whitening treatments.
To avoid confusion about what skin bleaching or skin whitening entails, let’s first get the definitions sorted. Skin bleaching or skin whitening involves lightening one’s natural and genetically inherited complexion to achieve a fairer skin tone. Skin bleaching is different from pigmentation lightening, which refers to getting rid of unwanted dark spots on the skin that have been acquired from sun exposure, hormones…etc. Examples of pigmentation are melasma, post inflammatory hyperpigmentation, freckles and solar lentigo.
To learn how to choose skincare to lighten your skincare, here’s my guide to lightening pigmentation and dark spots with skin care. This review will also talk about one of the latest pigmentation lightening creams in Singapore called Cyspera cream or Cysteamine.
There is some overlap between skin whitening and pigmentation lightening. Both treatments involve the removal of melanin from the skin. Melanin is the brown coloured pigment that gives our skin and pigmentation its colour. Some medications like hydroquinone can be used to achieve both pigmentation lightening and skin bleaching, albeit at different dosages.
Skin whitening is a controversial topic because of the many of these skin bleaching treatments have inadequate scientific data to support the practice. Additionally, these skin whitening treatments can cause dangerous side effects. These side effects include cancers, kidney failure and blood borne infections. These safety concerns and inadequate data have led to countries such as Singapore, European Union and many African nations to ban skin lightening treatments1.
Again, let’s be clear whether we are talking about lightening unwanted and uneven pigmentation versus bleaching one’s complexion.
Pigmentation or hyperpigmentation is one cause of uneven and dull complexion. The top three types of pigmentation in my practice in Singapore are: melasma, sun-related spots (e.g. solar lentigenes) and post inflammatory hyperpigmentation related to acne. These types of pigmentation can be removed safely with a combination of medications, skincare, laser and chemical peels.
A very safe combination for most of my patients (that I use for myself too) is skincare containing vitamin C, Q-switched laser and chemical peels. This particular combination of Q-switched laser and chemical peel gets rid of unwanted hyperpigmentation; blemishes and dull skin for more even and brighter skin tone. If your overall skin tone is darker, say from sun exposure after a holiday, this combination is also safe and effective to lighten your tan for overall fairer skin.
To learn more about treating pigmentation with laser and chemical peels, please read these posts 10 Things to Know Before Having Lasers for Your Pigmentation and The Truth About Chemical Peels.
In contrast, skin bleaching to lighten one’s natural and inherited skin tone is mainly achieved with skin bleaching cream and intravenous whitening drips. Let’s learn about both these treatments.
Skin bleaching creams contain ingredients to lighten the skins. These creams lighten the skin by reducing the amount of melanin in the skin. Two of the most well known and controversial skin whitening ingredients in such creams are: mercury and hydroquinone.
Update June 2020: Skin whitening creams are back in the spotlight again, following social media posts by Asian celebrities against racism and police brutality. The death of George Floyd, an African-American who died in US police custody, has ignited protests and movements against racism on social media. Asian celebrities like Priyanka Chopra have shared their support for George Floyd and the movement against racism. However, these celebrities were met with backlash for perceived hypocrisy by the public for promoting skin whitening and bleaching creams.
Mercury in Skin Lightening Creams
Mercury is a toxic substance commonly found in numerous skin bleaching creams. Mercury inhibits the activity of tyrosinase, one of the most important enzymes for the production of melanin. Several countries have banned the use of mercury in skin care. These countries include the European Union and numerous African nations1.
Reports in medical literature that have shown instances of mercury poisoning from skin lightening creams5. Short term use of mercury containing creams can cause skin discolouration and rashes. In the long terms, some of the dangers of mercury use include nerve damage, kidney failure, brain damage, seizures and deafness5. The use of mercury containing skin bleaching creams during pregnancy can also cause permanent neurological damage in children. Family members are also at risk of mercury poisoning from inhalation of mercury vapour from the skin due to the volatile nature of mercury6.
In Singapore, the use of mercury in cosmetic products is prohibited. However, that has not stopped the influx of mercury containing skin whitening creams into Singapore. Recently this year, the Health Science Authority (HSA) of Singapore flagged five skincare creams for containing mercury, with one of the creams exceeding permissable limits by more than 40 000 times7.
Update Dec 2019: A Californian woman is now in coma after using a skin lightening cream tainted with methylmercury from Mexico for 7 years. Read more this case in report by CNN.
One way to tell if your skincare contains mercury is to scrutinise the ingredient list for names like mercury, Hg, mercuric iodide, mercurous chloride, ammoniated mercury, amide chloride of mercury, quicksilver, cinnabaris (mercury sulfide), hydrargyri oxydum rubrum (mercury oxide), mercury iodide. However, the companies that manufacture these products may not list mercury as an ingredient for obvious reasons.
Hydroquinone in skin bleaching creams
Another common ingredient in skin bleaching creams is hydroquinone. Hydroquinone lightens the skin by affecting the key enzyme, tyrosinase, for the synthesis of melanin Hydroquinone is a powerful skin lightening ingredient and is regarded as the gold standard treatment for melasma. However, because of the side effects of long term use of hydroquinone, it is not prescribed long term. Some of these side effects include onchronosis, skin irritation and darkening of pigmentation.
There isn’t a clear consensus on the safety of hydroquinone globally in the scientific community. Hydroquinone in skin lightening products is banned in several countries such as the European Union, Japan, and several African nations like Ghana, Ivory Coast, and Rwanda. The US FDA however, considers hydroquinone to be safe.
In Singapore, you can find hydroquinone commonly as a cream called Triluma. Triluma (a combination of hydroquinone, retinoid and steroid) is used to treat melasma. Hydroquinone containing creams can only be obtained with a doctor’s prescription in Singapore.
Another controversial treatment popular in Asia for skin lightening is skin whitening drips. These drips are sometimes known as ‘Cinderella drips’ or ‘Gluta drips’. Despite the popularity of this treatment, there is a lack of evidence to support the use of these whitening drips.
What are skin whitening drips? What do these skin whitening drips contain?
Skin whitening drips are intravenous cocktails of glutathione,vitamins and other nutrients, given through a vein. These skin lightening cocktails are said to have brightening and whitening effects on the skin. Celebrity fans of these cocktail drips are rumored to include Adele, Kendall Jenner and Gwyneth Paltrow. Sometimes these whitening drips are administered as part of a IV vitamin drip (called IV micronutrient therapy) for treating fatigue, hangover and general health.
One of the key ingredients in whitening drips is glutathione, an antioxidant naturally found in humans. I’ve shared about glutathione as an ingredient in skincare in my post on skincare ingredient that lighten pigmentation. Glutathione causes skin lightening by converting melanin to a lighter colour (pheomelanin) and inhibiting one of the key enzymes in pigmentation formation called tyrosinase.
You might also find glutathione familiar because I’ve shared about glutathione in a post on Skinboosters. Glutathione can be directly injected into the skin for skin brightening. This is usually done as part of a Skinboosters cocktail, where hyaluronic acid and other antioxidants are injected into the dermis of the skin for skin hydration, brightening and treatment of pores. Skinboosters are permitted in Singapore and it is a popular treatment for dull, dehydrated skin and large pores in Asia.
Do whitening drips work? What are the results of these skin lightening drips?
Most of the evidence that IV whitening drips proponents and manufacturers point to comes from individual case reports or anecdotal experiences. In spite of its widespread use for skin bleaching, there are no rigorous, large scale studies on the efficacy of IV glutathione for skin lightening or its long term side effects8.
The only clinical evidence of IV glutathione for skin lightening that is often quoted by supporters is limited to a single study with dubious study design, flawed anaysis and adverse reactions occurring in patients treated with IV glutathione drips9.
Are whitening drips safe? What are the side effects of skin lightening drips?
Some of the adverse effects of whitening drips containing glutathione include thyroid dysfunction, kidney dysfunction and liver dysfunction8. In the only study available for IV glutathione for skin bleaching quoted above, 32% of patients treated with IV glutathione suffered from liver dysfunction after their whitening drips9. Potentially fatal drug reactions to the skin such as Steven- Johnson syndrome and toxic epidermal necrolysis due to whitening drips have also been reported9.
Blood borne infections are also lethal complications from non-sterile techniques and use of counterfeit intravenous glutathione from questionable sources. As detailed in my blogpost Vampire Facials and Platelet Rich Plasma (PRP), two patients were infected with HIV after receiving PRP/ vampire facials at a beauty salon in the US, highlighting that these safety concerns are not to be taken lightly.
Where can I find skin whitening drips in Singapore?
Whitening drips are banned in Singapore by the Ministry of Health. The use of intravenous glutathione and vitamins for skin lightening purposes are not permitted in Singapore.
Although whitening drips are permitted in some countries like South Korea and the US, the use of IV glutathione for whitening or skin brightening drips are considered off-label use. One of the world’s largest regulatory body for drugs and medical devices, the US Food and Drug Administration (US FDA) has not approved any injectable drug for skin whitening and skin lightening10.
In the Philippines, where the administration of IV whitening drips is rampant, several adverse effects have been reported from the off-label use of IV glutathione for skin whitening. This has promoted the Philippines’ FDA to release a public warning on the dangers of unapproved use of IV glutathione and the serious health consequences of glutathione whitening drips11.
Related blogpost:
Why Are Mesotherapy Fat Dissolving Injections Banned in Singapore?
I recently came across a sponsored ad on Instagram from a Malaysia based beautician offering whitening drips among other medical treatments like jaw slimming on Instagram. Above are screenshots that I took. This Malaysia based beautician seems to be illegally operating out of hotel rooms and apartments and offering whitening drips in Singapore. This is incredibly dangerous and it reinforces what I have mentioned about the dangers of getting treatments or injections from dodgy, non-medical practitioners. Not only is the hygiene suspect, what you are getting injected into your body also cannot be verified. Please do not be tempted to seek any form of medical treatments from questionable sources!
I have deliberately erased the name and locations of this beautician to avoid giving her unwanted traffic.
So far, this review on skin lightening creams and whitening drips has focused mainly on the science and safety concerns of these treatments. However, in spite of cultural and social biases for fairer skin in some cultures, this pursuit of fairer skin comes at a price too.
All this melanin produced by our bodies is not in vain; melanin serves a protective purpose for our skin. Melanin serves as natural sunscreen filter that reduces UV damage to the skin12. The sun protection factor (SPF) of melanin is possibly as high as SPF 4, according to one study12. Another study that compared White (Caucasian) and Black (African-american) skin also found that the Caucasian subjects who had fairer skin were susceptible to more than twice the amount of UVA and UVB rays penetrating the skin compared to their African-american counterparts with darker skin13
This protective effect of melanin/pigmentation is also supported by the inverse relationship of skin pigmentation and the likelihood of sun-induced skin cancers14– subjects with White skin are almost 70 times more likely to develop skin cancer than subjects with Black skin15.
Currently, skin whitening treatments lack robust scientific evidence to support its use. Two skin whitening practices- skin bleaching creams and skin whitening drips- may contain toxic ingredients like mercury and can be dangerous to users. Serious complications like liver failure and neurological dysfunction from skin whitening creams and lightening drips have been reported in users.
There is also no global consensus on the practice of skin bleaching- controversial ingredients like mercury and IV glutathione are banned in some countries like Singapore but not all countries. There is also the problem of skin whitening creams and IV drugs sold online or purchased overseas containing toxic concentrations of these ingredients, putting the health of consumers at great risk. I would advise you not to purchase such products or treatments online or overseas, especially when you are not sure about the legitimacy of the source and what is really going into these creams or drips.
As a doctor, I would also advise against skin bleaching because of the dangers of using these ingredients against a background of inadequate scientific data to support its use. In my opinion, it would be healthier to embrace your natural skin colour and focus on healthier mindsets and skin together with safe skin care habits and medical treatments. There is beauty and strength in self acceptance and being comfortable in your own skin. In the moving words of Lupita Nyong’o “What is fundamentally beautiful is compassion for yourself and for those around you. That kind of beauty enflames the heart and enchants the soul…There is no shade to that beauty.”
1.Mercury In Skin Lightening Products. World Health Organisation. 2011.
2.Skin Bleaching and Dermatologic Health of African and Afro-Caribbean Populations in the US: New Directions for Methodologically Rigorous, Multidisciplinary, and Culturally Sensitive Research. Benn et al.Dermatol Ther (Heidelb). 2016 Dec; 6(4): 453–459.
3.https://cosmetics.specialchem.com/news/industry-news/skin-lightening-products-market-to-reach-usd23-bn-by-2020-global-industry-analysts
4.https://www.prnewswire.com/news-releases/cosmetics-market-is-expected-to-reach-39007-billion-globally-by-2020—allied-market-research-505160571.html
5.Characteristics of Mercury Intoxication Induced by Skin-lightening Products. Sun et al. Chin Med J (Engl). 2017 Dec 20; 130(24): 3003–3004.
6.https://www.fda.gov/consumers/consumer-updates/mercury-poisoning-linked-skin-products
7.https://www.todayonline.com/singapore/five-cosmetic-creams-found-contain-mercury-potent-prohibited-ingredients-hsa
8.Glutathione for skin lightening: a regnant myth or evidence-based verity? Sonthalia. Dermatol Pract Concept. 2018 Jan; 8(1): 15–21. https://www.ncbi.nlm.nih.gov/pubmed/27499402
9.Efficacy of intravenous glutathione vs. placebo for skin tone lightening. Zubair et al. J Pak Ass Dermatol. 2016;26:177–181.
10.https://www.fda.gov/consumers/consumer-updates/injectable-skin-lightening-and-skin-bleaching-products-may-be-unsafe
11.Safety on the off-label use of glutathione solution for injection (IV). Lazo. Food and Drug Administration, Department of Health; Republic of the Philippines: 2011.
12.Photoprotection by melanin–a comparison of black and Caucasian skin. Kaidbey et al. J Am Acad Dermatol. 1979;1:249–260.
13.Skin cancer in African Americans. Halder and Bridgeman-Shah. Cancer. 1995;75:667–673.
14. The pathogenesis of melanoma induced by ultraviolet radiation. Gilchrest et al.N Engl J Med. 1999;340:1341–1348.
15.Skin cancer in blacks in the United States. Halder and Bang.Dermatol Clin. 1988;6:397–405.
