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In the context of pigmentation, it works through two mechanisms that make it particularly effective as a hyperpigmentation treatment

In cells containing mitochondria, ALA is reduced in an NADH-dependent reaction with lipoamide dehydrogenase to form dihydrolipoic acid (DHLA), whereas in cells that lack mitochondria, ALA can instead be reduced to DHLA via NADPH with glutathione (GSH) and thioredoxin reductases (Jones et al., 2002)

Because of these risks, many dermatologists and medical bodies strongly discourage the use of injectable glutathione for cosmetic/lightening purposes

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