Impact of Aesthetic Treatments on Self-Esteem in Females with Body Dysmorphic Disorder: A Cross-Sectional Comparative Study

Abstract

Background: The cosmetic application of glutathione (GSH) for skin tone lightening has expanded substantially across aesthetic and dermatological practices in recent years. Although glutathione is a well-characterised endogenous antioxidant with established therapeutic roles in oxidative stress management, hepatoprotection, and chemotherapy-induced toxicity, its off-label use for cosmetic depigmentation remains controversial, unsupported by robust clinical evidence, and largely unregulated in many jurisdictions.

Objective: This study critically examined the patterns of glutathione use for skin tone lightening among a sample of Pakistani users, evaluating perceived effectiveness, frequency and nature of adverse effects, and user awareness of associated safety and regulatory concerns across oral, topical, and intravenous routes of administration.

Methodology: A descriptive, cross-sectional study was conducted over four months at selected aesthetic clinics and dermatology practices in Lahore, Pakistan. A structured, pre-validated questionnaire was administered to 200 confirmed glutathione users. Data were analysed using SPSS v27, employing descriptive statistics, independent Chi-square tests, and Spearman correlation analyses.

Results: Females constituted 60.5% of users. The intravenous route was most frequently used (38.0%), followed by oral (26.0%) and topical (17.5%) administration. Most participants reported mild to moderate skin tone improvement (65%); however, 21.0% reported no appreciable benefit. Adverse effects were reported by 68.5% of respondents, with injection-site reactions (31.0%), nausea (21.0%), and liver-related complaints (12.5%) being most prevalent. Statistically significant associations were identified between gender and motivation for use (χ² = 29.34, p = 0.0004) and education level and perceived improvement (χ² = 57.82, p = 0.0002).

Conclusion: Although glutathione may confer modest, transient cosmetic benefits in some users, its effectiveness is inconsistent and its safety profile, particularly with intravenous administration, raises serious clinical and public health concerns. The findings underscore the urgent need for strengthened regulatory frameworks, evidence-based clinical guidelines, and enhanced consumer education surrounding the cosmetic use of glutathione