Depigmentation: To Pursue or Not to Pursue

There has been some misunderstanding in our communities in regards to depigmentation. We have to admit they are people out there who use certain products to lighten their skin complexion at the same time there is depigmentation for vitiligo patients. This article intends to enlighten how skin depigmentation works. Enjoy!!

If you have vitiligo, you most likely have heard of depigmentation, the process by which the remaining pigment is permanently removed from the skin and wondered where it fits into vitiligo treatment. Is it something you should consider?

People who consider depigmentation have reached a point where medical therapy no longer offers hope for controlling their disease. Generally, the vitiligo has become so severe that one has come to the place where you either continue to live with the diseases progression or depigment. Some who have extensive vitiligo find it preferable, and easier, to depigment the remaining unaffected skin rather than try to repigment the vitiligo-affected skin.

Even though one reaches the point of considering depigmentation, making the actual decision to go forward is not an easy one. Depigmentation is permanent, irreversible. There are many concerns and even fears that naturally arise. For example, will the pigment come back? Are there skin reactions?

People of non-white ethnicity face additional concerns about loss of racial identity, as well as cultural and social concerns that also must be addressed prior to starting treatment. How will family and friends respond? Will people still accept me if I am a different color?

Depigmentation therapy is designed to remove the remaining pigment in the skin to match the areas that are already white. For people who have vitiligo on more than 50% of their bodies, depigmentation may be the best treatment option.

A dermatologist must decide whether this treatment is appropriate. A recent survey showed that dermatologists vary in their opinion as to who should be eligible for this therapy. The survey showed that 42% of dermatologists are in favor of depigmentation when vitiligo affects more than 50% of the body, while 32% feel that patients must wait until it affects more than 75% of the body.

In general, depigmentation is limited to the patient for whom repigmentation therapies have failed and/or has more than 50% pigment loss in their skin or when the depigmentation is extensive in the cosmetically sensitive areas of the hands and face. Depigmentation is not generally recommended for children.

The main method used to depigment vitiligo-affected skin is the topical application of monobenzyl ether of hydroquinone (MBEH) (also referred to as monobenzone). MBEH is a topical prescription product applied to the pigmented areas. This is the only drug approved by the FDA for depigmentation therapy of advanced vitiligo. For many years, MBEH was available under the brand name Benoquin, but it has now been discontinued by the manufacturer. MBEH is now only available as a compounded product (monobenzone powder added to a base cream) made by specialized pharmacies

A cream with a 20% concentration of MBEH is applied twice a day for 3-12 months. It is important to understand that this is a systemic treatment, meaning that regardless of where the cream is applied, it will affect the entire system or body and areas away from the treated area will still lighten. This is not a treatment used to selectively lighten or depigment a specific or confined area. Treatment will generally begin with a concentration of 20% MBEH. Depigmentation should begin after 3 to 4 months of application. The concentration is frequently increased to 30% or 40% during the process, but MBEH concentration greater than 40% is not recommended. If the vitiligo has been stable for years, a longer duration of therapy and higher concentration of MBEH may be required. Direct skin-to-skin contact with other people must be avoided for at least two hours after applying the drug, as transfer of the drug may cause depigmentation of the other person’s skin

 According to a study on the effectiveness of MBEH in the depigmentation of vitiligo patients. It is a retrospective study where researchers at Massachusetts General Hospital in Boston looked back at the experience of 18 vitiligo patients who underwent MBEH therapy. The patients ranged in age from 26 to 68 years of age and had had vitiligo from 6 months to 51 years. Fifteen were women and three were men. Two of the patients were African American and sixteen were Caucasians. The patients had 40 to 90% depigmentation prior to beginning treatment with MBEH. In only one patient was the vitiligo rapidly progressive at the time. The remainder of the patients had stable or slowly progressing vitiligo. The treatment protocol involved the twice-daily application of 20% MBEH.

Of the 18 patients:

Eight (44%) severely-affected vitiligo patients achieved complete depigmentation. Their first signs of depigmentation occurred within one to six months (average under three months) of the start of therapy and full depigmentation was achieved in 4 – 12 months. Furthermore, after six months of MBEH use, one of these eight patients, who had experienced partial depigmentation, continued on to completely depigment after discontinuing MBEH.

The researchers observed that the average patient in the trial did not begin to depigment until after two-three months or more of application of the MBEH, and also found that the time of the first appearance of depigmentation was not predictive of the final degree of depigmentation. They concluded that consistent use of MBEH correlated with the eventual success of depigmentation. They reported that all those who depigmented fully said they were very pleased with their results. Two of these patients were African American.

In terms of side effects, seven of the 18 patients reported no complications. In two cases, the sensation of burning lasted only the first month of therapy. In two other patients it did limit therapy; however, mixing the MBEH with an emollient helped relieve the burning in these patients. Severe contact dermatitis did cause one patient as described above to drop out of the trial. Other side effects observed were redness or rash, dryness, and swelling.

The study’s authors concluded that MBEH was effective, produced generally satisfactory results, and involved limited side effects. They concluded that treatment should lead to an onset of depigmentation within three-six months of therapy being started and full depigmentation within a year. They cautioned that occasional use thereafter may be required.

One of the concerns frequently expressed by those interested in depigmentation is whether the process increases their risk of serious skin cancers like melanoma. A study coming out in April 2011 concludes that using MBEH may actually be helpful to prevent the occurrence of melanoma in those with a family history of the disease. Since melanoma is cancer of the melanocytes, and the melanocytes are destroyed by using MBEH, it has long been reported that the risk of melanoma is low to non-existent in those who have completely depigmented.