Depigmentation Therapy for Vitiligo

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Vitiligo or leukoderma is an autoimmune skin condition that results in partial loss of skin pigmentation cells. Pigmentation cells called ‘melanin’ are responsible for our skin colour and absence of them results in white milky patches over the skin surface. The condition can affect any part of the body and cause white patches. However, commonly the condition starts appearing in the sun-exposed areas of the body such as face, lips, hands, feet, neck etc. Depending on the severity of the condition, doctors for white marks on the skin suggest various treatment. Depigmentation treatment is one of such treatment processes.

Depigmentation therapy:

Depigmentation therapy can be best described as a medical procedure to remove skin pigmentation cells. It is mostly used for patients with widespread vitiligo but has few patches of original skin colour left.  In simple words, people who have incomplete vitiligo on faces or other body parts can go under this treatment. It improves their appearance by giving an even skin tone.

This depigmentation therapy for vitiligo is done by using many methods such as Monobenzyl ether of Hydroquinone (MBEH), Topical Diphencyprone (DPCP), Imiquimod, Phenol, Cryotherapy and Lasers. Among them, Monobenzyl ether of hydroquinone and lasers are most commonly used and tend to deliver the best results. Doctors for white marks on the skin often use combination therapy as well for faster & better results.

This depigmentation therapy is considered for people with more than 50% widespread vitiligo and has patches over the body parts that are exposed or sensitive to cosmetics. It is necessary for the patients to understand some facts about the depigmentation therapy prior to taking it. These factors must be discussed with the patient to let them understand the process & side effects. These factors may include:

  • Nature of the treatment
  • Care and protection needed for the long run. For example, people undergone depigmentation therapy need to wear medicated sun protection to maintain the benefits of this therapy and reduce the risks of sun damage, cancer or other skin conditions.
  • Longer downtime and requires ‘touch–up’ sessions.
  • May have side effects depending on various individual factors.
  • Repigmentation can be patchy for a while.

Patients should be given the opportunity to discuss treatment options with their family and friends.

Monobenzyl ether of hydroquinone

Doctors for white marks on the skin commonly uses MBEH or monobenzone as the depigmenting agent to treat vitiligo patches. It is the only medically approved depigmentation therapy agent for treating vitiligo. It is a derivative of hydroquinone which causes irreversible depigmentation by killing the pigmentation cells. Depending on the individual, doctors may suggest different concentrations. The concentration also depends on the area to be treated for.

Side-effects also may cause after MBEH application, but they are mostly mild ones. If MBEH application causes transient irritation or burning sensation to the patient’s skin, then the doctor may stop the treatment for a while. In the case of blistering, scaling or dry skin, the doctor may suggest some topical corticosteroids cream to apply and stop the process for a while. If any of these side-effects happen, the doctor may reduce the strength of MBEH for next sessions. Very few cases of contact allergic dermatitis are found as a side-effect of this treatment which resulted in the permanent stop of this treatment. Few cases of exogenous ochronosis or ashy brown pigmentation have been seen after prolonged use of MBEH treatment. However, all these side-effects occur very rarely and only a few cases have been found around the world.

Application of monobenzyl ether of hydroquinone

Before starting the treatment, best clinics for white patches on the body always carry a tolerance test for MBEH. Under the tolerance test, the patient is given MBEH cream to apply daily for a week or two to apply in a small area such as inner upper arm or elbow. If no side effects experienced in this period, then patients are advised to proceed.

The MBEH creams are usually instructed to apply once daily for two weeks and then increase the daily application frequency. The creams should be applied around the pigmented area to lighten them. Such creams should not be applied on the eyelids or mucosal surfaces. Also, while under this treatment, the patients are advised to avoid sun exposure as that can cause repigmentation in the patches.

Usually, the treatment takes 1-4months to achieve desired results, but there are instances when vitiligo patients have to continue it for a longer period. However, the duration varies from patients to patients depending on various factors and their vitiligo patches.

It is always advised that if desired outcomes are not achieved within 4 months of use than this treatment should be discontinued. Once the cream has delivered the desired results, the patients need to use them intermittently as a maintenance routine. Usually, post-treatment applications are advised to do for twice a week, but it may vary for individual. Also, post-treatment, the patients need to apply SPF50+ broad-spectrum sunscreen daily to avoid repigmentation and sunburn.

Why professional services matters?

Taking depigmentation therapy services from random clinic never deliver the desired results and also could cause serious side effects. In the best clinics for white patches on the body, professional dermatologists do the proper skin test before proceeding with the treatment which minimizes the chances of side-effects and assures the best outcome.

Cleanliness is a Bad Habit

Of late I have been seeing so many patients in our Dermatology OPD with hands which are dry, parched, itchy, irritated and have got cuts. Their history points out to a peculiar habit of washing their hands frequently and as I dig deep into the number of times their hands are subjected to scrubbing, soaps, hand washes, sanitizers, wet tissues etc.

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Ok, let me rephrase. Over cleanliness is a very BAD habit!

Of late I have been seeing so many patients in our Dermatology OPD with hands which are dry, parched, itchy, irritated and have got cuts. Their history points out to a peculiar habit of washing their hands frequently and as I dig deep into the number of times their hands are subjected to scrubbing, soaps, hand washes, sanitizers, wet tissues etc., it is mind-boggling. Most of these patients wash their hands at least 10-15 times a day, some sheepishly admit it to be 30 and sometimes the accompanying attendant will point it out to be even more!

Most of these patients are highly intelligent or shall I say too intelligent and are perfectionists, highly successful men, and women and somehow the cleanliness bug has bitten them. Even though they do understand the issue they somehow don’t and even on explaining the problem to them, they very reluctantly nod their heads in affirmation.

Now we all see beggars on the road, children running around bare feet, we see Rickshaw pullers, laborers and many more, but, how many times do they wash hands with all these fancy soaps & sanitizers? We all know the answer-hardly…Still, they maintain good health, may be better than what most of us do.

So the logic lies in the fact that God has given us a superb Defense System; what we Doctors have given a fancy name to, ‘Immune System. So we have to get EXPOSED so that our defense, our Army stays on its toes else it gets lethargic or worse, misdirected leading to the “problems of the clean”.

So, friends, cleanliness is good, over cleanliness is very bad, and the next time you want to reach out to that sanitizer bottle which for your information contains 66% alcohol, think twice. You really don’t need it, let your inner immune system take care of the small stuff and as I always quote have ‘Faith in the Lord’.

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