Depigmentation Therapy for Vitiligo

Vitiligo is a skin condition characterized by the loss of pigmentation, or colouration, in isolated areas of the body. The causes of vitiligo are not precisely known. But it is believed to be due to autoimmune and genetic factors. Its symptoms are white patches on the skin and loss of colour in the affected area. Contrary to some people's beliefs, it is not dangerous or contagious!

While vitiligo is typically not painful or physically debilitating in any way, the condition may generate considerable psychological distress for those it impacts. 

Several treatment options for vitiligo include topical steroids, light therapy, and surgical treatments. 

Depigmentation therapy, also known as monobenzone therapy, is a therapy for vitiligo. This involves the application of a topical cream (monobenzone) to the unaffected skin of a person afflicted with vitiligo to uniformly eliminate skin colouration. 

Depigmentation therapy is generally considered effective for most individuals it is applied. It can help reduce feelings of psychological and social distress. 

What is depigmentation therapy?

Depigmentation therapy uses drugs to remove the pigment from the skin. It is most often used to treat vitiligo. The drugs that are used for depigmentation are typically hydroquinone or monobenzone. 

During this procedure, a topical lotion is applied over the normal skin to bleach the remaining pigment and produce the same colour as the depigmented skin. 

Hydroquinone inhibits the production of melanin, the pigment that gives skin its colour. Monobenzone destroys melanocytes, the cells that produce melanin.

Depigmentation therapy can treat vitiligo on any part of the body. The cream is applied to the unaffected, or relatively unaffected, areas of the body to decrease the pigmentation to match the other depigmented areas.

This process typically takes anywhere from one month to a year or even more to be completed and is generally less expensive than other treatments for vitiligo. The ointment must be cautiously applied and may cause mild to moderate irritation, burning, stinging, or itching. However, these side effects usually fade within a few days of using the cream.

One of the latest additions to the arsenal of topical treatments approved by the United States Food and Drug Administration (USFDA) is opzelura cream to treat vitiligo in adult and pediatric patients aged 12 years and older.

The depigmentation procedure is usually permanent and exposes the skin directly without protection from sunlight. There is a chance of repigmentation, which may differ from the patient's original skin colour. Also, applying depigmentation ointments over one part of the skin can sometimes lead to loss of pigmentation of the skin of other parts of the body.

Risks associated with depigmentation therapy

Depigmentation therapy is generally considered a safe and effective method of treating vitiligo. However, there are a few potential risks that may arise. 

When used in high doses, monobenzone can cause genetic mutations, potential irritation, and immune suppression. Additionally, depigmentation results may be permanent, and some people may not be entirely satisfied with the appearance of the depigmented skin. Thus, individuals must consult with a dermatologist before engaging in the treatment.

Who is a candidate for depigmentation therapy?

Depigmentation therapy is usually recommended for people with vitiligo who have:

• White patches covering more than 50% of their body
• Failed to respond to other treatments, such as topical corticosteroids or phototherapy
• Are not candidates for, or do not want, other treatments, such as skin grafts or surgery

Are there any side effects of depigmentation therapy?

Yes, there are some side effects of depigmentation therapy. The most common side effect is skin lightening beyond the desired area. Other potential side effects include redness, itching, and blistering of the treated skin. In rare cases, permanent scarring may occur.

How long does depigmentation therapy take?

Depigmentation therapy takes about 1-4 months, but the complete process may take up to a year. The first year is usually the most difficult as the body adjusts to a new skin tone. After that, the skin gradually lightens over time.

Natural depigmentation therapy for vitiligo

Herbs used by traditional African healers for voluntary depigmentation are useful. These are Brillantaisia cicatricosa Lindau, Chenopodium ugandae, Dolichopentas longiflora Oliv., Protea madiensis Oliv., Sesasum angolense Welw., Ethanolic extracts of the leaves of the plant Myrica rubra. 

The in vivo studies involving these plants have indicated that they may have effects on the production of melanin by melanocytes. Future studies should examine these herbs in more detail.

Latest treatment therapies for depigmentation

Imatinib, or imatinib mesylate, is a drug for treating diseases like leukemia and gastrointestinal stromal tumors. But generalized depigmentation was observed as a side effect in patients treated with this drug. This drug inhibits the activity of the enzyme tyrosinase kinase, which results in decreased skin pigmentation. However, other side effects include fluid retention, diarrhea, etc.

Another topical drug is Imiquimod, used to treat anogenital warts and basal cell carcinoma. It was observed that its prolonged use, too, resulted in depigmentation.

A drug used to treat alopecia areata is diphencyprone (DPCP) and also has depigmentation as a side effect.

In a clinical case study published in 2021, 88% topical phenol was used as a short-term depigmenting agent in vitiligo.

How much does depigmentation therapy cost?

The cost of depigmentation therapy for vitiligo can vary depending on the type of therapy and the severity of vitiligo. However, on average, patients can expect to pay between Rs. 3,000 and Rs. 3,50,000 or more. Each session lasts around 30 minutes. Most insurance companies will not cover the cost of depigmentation therapy, so it is important to check with the provider before scheduling an appointment.

Other treatment options for vitiligo

• Topical medications are typically used first, as they are the least invasive option and bleach the skin and even it out.
• Laser therapy works similarly but has many advantages including effectiveness, speed, safety, and a short duration of treatment.
• Cryotherapy, another physical agent like a laser, is best used when rapid depigmentation is required. Also, cryosurgery is cost-effective, and produces excellent cosmetic results but only on limited areas of skin at a time.
• Surgery is usually only an option when other treatments have failed. Surgery involves removing the top layer of skin, which contains most of the pigment cells. This can cause scarring, so it is only done as a last resort.

Still wondering about depigmentation therapy?

Vitiligo is a skin condition producing white patches and lots of anxiety in patients. Though the exact cause of vitiligo is unknown, various treatment options are available.

Depigmentation therapy offers an effective way to treat vitiligo. It is an excellent alternative therapy for patients who have extensive and widespread vitiligo covering more than 50% of their skin and have cosmetic disfigurement due to intervening patchy pigmented areas. It is also ideal in patients with whom phototherapy has proved ineffective. The good thing is that it can be used in all skin types. 

It can be considered a last resort for vitiligo patients. Still, as with any medical procedure, weighing the potential benefits and risks is important before embarking on this type of treatment. 

While depigmentation therapy may not be for everyone, those who pursue it can rest assured that they receive top-notch care from skilled professionals. With a little research and the doctor's help, one can make an informed decision about whether or not depigmentation therapy is right for them.

People with vitiligo should not lose heart. Take a step closer to depigmentation of the skin. UnCover’s panel of experienced dermatologists will decide the right course of treatment and a proper plan for better skin. UnCover has nearly all the tools for perfect skin. Book a free consultation today. We are always committed to improving the appearance of the skin. Let us improve overall health with our latest and up-to-date treatments. Get in touch with us now.