Depigmentation requires the topical application of a cream containing
monobenzylether of hydroquinone and leads to total, permanent whitening of
the skin all over the body. This therapy is only an option for patients with
Vitiligo patches covering more than 50% of their body and who have not
responded to previous repigmentation treatments. Basically, it is easier
for them to lighten the rest of their skin to match the more numerous
white areas, rather than repigmenting huge areas of skin.

Many people are reluctant to undergo depigmentation, as it can produce
the shocking result of totally white skin similar to that of Albinos
despite the patient's initial skin color. People fear that they will be
too light and that they will burn when they go out in the sun (no pigment
means no sun protection!). However, most patients feel extremely satisfied
with the results. In fact, more than 50% of the patients that who begin
depigmentation therapy are able to continue to total depigmentation and
are overjoyed to see themselves as one skin color.



Depigmentation is a very slow and careful process. Complete depigmentation
can take one to four years, with topical cream applications to affected areas
twice a day (sounds expensive!). The most widely used commercial cream is
called Benoquin, which contains 20% monobenzylether of hydroquinone.

Procedure:

Photographs are taken of both arms. Then Benoquin with 20% monobenzylether
is applied to one arm for two to three months to test for response or for
allergic reactions.

A stinging feeling may occur after application. This is normal and should
only last a few minutes. And allergic reaction tends to appear as a rash
within a few days after application.

Patient returns after two to three months, and photographs are taken again.
The treated arm should be a much lighter color than the untreated one.
Once the treated arm has become noticeably lighter, the patient applies
the cream to the hands, arms, and face.

While these areas are depigmenting, other parts of the body where no cream
was applied usually lighten as well.

The process continues until the patient has fully depigmented to one color.
Eye color will not change.


If the patient does not respond to the Benoquin with 20% monobenzylether, it
is possible to recieve a stronger preparation of 40% monobenzylether.

About 15% of patients develop a rash from this treatment due to an allergic
reaction. In this case, the concentration of monobenzylether can be diluted
from 20% to 1%. If there is no allergic reaction to this preparation during
one month, treatment goes on to a 5% preparation for a month, and so on
until the cream is back up to a 20% concentration.

Side Effects:

inflammation of skin (dermatitis)
itching (pruritus) or dry skin (xerosis)
abnormal darkening of membrane that covers the white of the eye
abnormal sensitivity to sunlight

Some people may repigment after treatment during the summer months,
especially on the face. Usually these spots can be treated with 20% Benoquin.
Rarely, patient response may stop and later repigment or even hyperpigment.
On these occasions, even a 40% concentration of Benoquin will not work...

... On the bright side, these select people may even continue to repigment
enough so that they no longer need to consider depigmentation treatment!