| DERMATOLOGY | PEER-REVIEW
of 4.99 and most patients (n=90, 31.8%) reported 5 on the scale of 1 to 7 (Table 5). Of the 283 patients, only three complained of mild
gastritis, two complained of chills, and two complained of headache. There was no severe complication noted in this study. In 7 years of administering Vit C and GSH injections,
the author realised that after each treatment protocol patients returned either monthly for maintenance injections or some patients returned for further injections after they came back from hot sunny overseas trips where their skin became tanned and dried. The author concluded from practical experience that
the duration of treatment results depends on three important factors: Environmental UV light exposure (for example, an outdoor job vs indoor job)
Amount of protection against UV light (patients were advised to carry an umbrella when walking under the sun)
Genetic conditions (patients with eczema tend to visit the clinic monthly for maintenance).
Discussion Most patients (n=270, 95.4%) perceived a certain degree of skin hydration and whitening after six Vit C and GSH intravenous injections and most patients (mean score 4.99 out of 7) were satisfied with the results. This supported the popular claim in Asia that Vit C and GSH injections had strong skin hydrating and whitening effects. This study showed that the skin enhancement and
whitening effects of Vit C and GSH injection were dose and time dependent. Most patients experienced improved skin hydration first, followed by increased radiance and fairness. The number of patients experiencing skin being less dry, more radiant and fairer also increased steadily from the second visit to the sixth visit (Table 4). This demonstrated that the efficacy of the Vit C and GSH was dependent on the number of injections received and some patients might require more than six injections to reach optimal skin enhancement whereby they felt that their skin was hydrated, fair, and radiant. This might also infer that improved skin hydration was the first step for skin repair and after adequate hydration, the skin will further improve to look more radiant and fairer (whitening effect). A person’s skin hydration, radiance,
and tone varies daily and even within the day itself. This variation is due to multiple factors such as the level of stress, amount of sleep, amount of sun exposure, working environment, hormonal cycle, and diet. Therefore, in this study, the author
Figure 1 Results of the study. (A) before first injection and (B) after sixth injection
reported how the patients felt about their skin conditions over the period of time between the injections, rather than just reporting on their skin conditions during the time of visit. To date, from the manufacturer’s published literature and a search on the Internet, the author found no contraindication for intravenous GSH injection. No side- effect has been reported from intermittent dose, short- term GSH supplementation. The contraindications for intravenous Vit C
supplementation is glucose-6-phosphate dehydrogenase (G6PD) deficiency13
and chronic renal failure14 . The author
would also like to highlight that in 2000, the recommended dietary allowance (RDA) set the tolerable upper limit (UL) of Vit C at 2000 mg daily, referencing its laxative effect as the reason for establishing the UL15
. In
this paper, the patients were given 2000 mg of intravenous Vit C, once a week. The author would like to emphasize that there was no issue of Vit C overdose in the context of this study. Some patients had raised the
concern regarding the formation of kidney stones due to a high dose of vitamin C supplementation. Their concerns can be traced back to a Swedish study by Thomas LD et al16
,
involving 23,355 Swedish men taking oral vitamin C supplements with a follow-up of more than 10 years. The results indicated that high-dose ascorbic acid are associated with a dose-dependent two-fold increased risk of kidney stone formation among men.
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