The primary goal of Vitiligo / Leukoderma therapy is to repigment the affected skin. However, it is not always possible. All the treatment modalities available for repigmentation may fail to achieve it. In this situation, depigmentation therapy can be considered.
Guidelines for Depigmentation Therapy:
- Unresponsive to therapy or unwilling to treat. Desire for permanent depigmentation in a patient with Vitiligo / Leukoderma.
- More than 50% of body surface area affected by disease.
- Willingness to accept that re-pigmentation is no longer possible.
How Does Depigmentation Benefit Vitiligo Patients?
Patients are disturbed because of two different skin colors, brown and white. Aim is to remove all residual brown colour to make skin uniformly white. For the patient, cosmetic disfigurement is no longer evident, helping to reduce social stigma.
What method is used to achieve Depigmentation?
Mononbenzyl ether of hydroquinone (MBEH) or monobenzone is the key to depigmentation. Local application of a cream containing MBEH leads to loss of melanocytes leading to de-pigmentation of the skin.
The patient applies MBEH 20% cream, once a day to a small patch of one arm for a week. This is to test for sensitivity. Thereafter, it is applied two times a day to the desired area. Patients will experience a gradual dilution of skin colour eventually turning white.
The entire process can take 1 to 2 years to achieve complete depigmentation. In some patients it may be longer, up to 4 years. We do not advise application of cream to entire body at one time. Application of monobenzone at one site usually leads to activation of vitiligo resulting in loss of skin colour at distant sites, e.g. application of MBEH to the arm may lead to depigmentation of the chest or abdomen.
Usually most patients will respond and de-pigment resulting in uniform white skin colour. Re-pigmentation of sun exposed areas is not uncommon, therefore avoidance of sun exposure is recommended. Recurrence is treated with application of monobenzone.
The use of MBEH should be done strictly under medical supervision.
Will the color of hair and eyes change?
The cream does not affect melanocytes of hairs. Colour of hair does not change. It is not advisable to apply on eyelids due to possible loss of melanocytes in eyes.
What are the adverse effects?
The most common side effect is an irritant reaction to the cream. A stinging feeling may occur immediately after the cream application and will last for a few minutes. If one is allergic, a rash will appear within 1 to 4 days after application.
In this situation, medicine is discontinued and restarted after the rash subsides. A lower concentration (e.g.5%) is used and gradually increased to 20%. Allergy occurs in the normal pigmented skin, and not in the white patches.
What are the precautions?
Avoid application to the eyelids and areas close to the eye. Avoid application at bedtime as the cream inadvertently may go into the eyes and skin-to-skin contact with family member will cause decrease in pigmentation at the site of contact.
For patients with widespread and resistant Vitiligo / Leukoderma, depigmentation therapy is a viable treatment option. For most patients loss of pigment is permanent. If anyone is ambivalent because of hope of future more successful therapies for Vitiligo / Leukoderma, they should not undergo depigmentation therapy.