In the U.S. skin care industry, the “brightening” category is a major one. It seems like everyone has a desire to get rid of dullness and discoloration, and as a result, there’s been a huge boost in these products on the market. Everything from serums and creams to supplements and laser treatments are touted as “skin brighteners,” but in other parts of the world, particularly Asia, there’s even more.

In regard to Asian beauty trends, we’re familiar with the 10-step skin care regimens and K-beauty surge we’ve seen throughout recent years, but there’s another, more “serious” trend, you may not be well-versed on: skin whitening, and people will do just about anything to achieve it.

“In every culture, there is a cultural and societal trend toward altering skin color,” says New York dermatologist Melissa Kanchanapoomi Levin, MD. “In many Western societies, individuals seek to tan their skin, as this is associated with a ‘healthy glow’ or having a lifestyle that consists of traveling and outdoor activities. In some Asian and African countries, darker-skinned individuals are in search of whitening or lightening agents. And in certain Asian countries, a lighter skin tone is a desirable trait for some, as it is associated with wealth and higher societal class.”

To feed this large societal demand for skin-lightening agents in Asia, Dr. Levin says many of the same treatment options that we favor in the U.S. are used, such as topical medications including hydroquinone, kojic acid, vitamin C, glycolic acid, arbutin, glycolic acid and retinoids. However, when the desired whitening supersedes what these topicals can deliver, there’s another treatment Asian women are turning to: injections of glutathione (GSH). “Glutathione is a naturally occurring antioxidant that plays a key role in important physiological processes such as neutralizing free radicals, detoxification and cellular breakdown of proteins,” explains Dr. Levin. “It was discovered to have antimelanogenic (or anti-pigment) properties through multiple pathways, but only in vitro, meaning in the petri dish, not in clinical trials.”

The countries where this injection (it’s performed intravenously; typically in the arm) is most prevalent are Vietnam, the Philippines and India—it’s actually illegal in Thailand, but oral and topical forms of the medication are available as alternatives and considered popular skin-lightening options in other countries as well, such as Malaysia, China, Korea and Taiwan. However, Dr. Levin says it is hypothesized that the intravenous form is more bioavailable than the oral form (meaning your body can actually use what is injected), but there are also no studies to support this. “Most importantly, the data on safety is very limited,” she adds.