The primary goal of Vitiligo/Leukoderma therapy is to re-pigment the affected skin. However, it is not always possible. All the treatment modalities available for re-pigmentation may fail to achieve it. In this situation, de-pigmentation therapy can be considered.
Guidelines for De-pigmentation Therapy:
- Unresponsive to therapy or unwilling to treat
- Desire for permanent de-pigmentation 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 De-pigmentation benefit Vitiligo patients?
Patients are disturbed because of different skin colours – brown and white. The aim is to remove the entire residual brown colour to make skin uniformly white. For the patient, cosmetic disfigurement is no longer evident, helping to reduce social stigma.
What is the method used to achieve De-pigmentation?
Mononbenzyl Ether of Hydroquinone (MBEH) or Monobenzone is the key to de-pigmentation. 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 on one arm for a week. This is to test for sensitivity. Thereafter, it is applied, two times a day, on the desired area. Patients will experience a gradual dilution of skin colour eventually turning white.
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 de-pigmentation of the chest or abdomen.
The entire process of complete de-pigmentation can take up to 1 to 2 years. In some patients it may take longer – up to 4 years.
Usually most patients will respond, resulting in uniform white skin colour. Re-pigmentation of sun exposed areas is not uncommon, therefore avoiding exposure to the sun is recommended. Recurrence is treated with application of Monobenzone.
The use of MBEH should be done strictly under medical supervision.
Will the colour of hair and eyes change?
The cream does not affect melanocytes of hair – which means the 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, if any?
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 of application. In this situation, the medicine is discontinued and restarted once 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, de-pigmentation 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 de-pigmentation therapy.
Disguising Vitiligo with make-up, self-tanning compounds or dyes is a safe and easy way to make it less noticeable. While most products are not waterproof, the waterproof ones are available at select centres. Self-tanning compounds contain a chemical (dihydroxyacetone), which gives a yellowish tinge and lasts for about 7 days. None of these change the disease, but can improve appearance temporarily. Tattooing of small areas may be helpful, especially for mucosal lips and areolas.
Certain types of Vitiligo (especially lip-tip types) are very resistant to all therapies. In fair-skinned individuals, avoiding tanning of normal skin can make areas of Vitiligo almost unnoticeable. Sometimes the best treatment for Vitiligo is no treatment at all.
Important Note: It is important to note that since no cause is known, there is no permanent cure for Vitiligo/Leukoderma. The disease can be treated to achieve re-pigmentation of Vitiligo patches, but it cannot be cured from the root.