Depigmentation Overview

Depigmentation is the absence or loss of pigmentation (or less than normal pigmentation) in the skin or hair.

Depigmentation of the skin is commonly linked to people who suffer with vitiligo who then apply a topical cream containing the organic compound monobenzone to remove the remaining pigment. The brand drug incorporating 20% monobenzone is Benoquin.

Depigmentation is the loss of coloration; bleaching. This may be caused by disease, improper diet, or old age.

These are only a few sources but all of them agreed about the absence or loss or pigmentation in normal skin or hair.

This is anecdoctal information based on limited experience. Please see an experienced dermatologist for guidance if you intend to depigment. And, use the SEARCH function to find past posts relating to your specific questions and interests.

When people with vitiligo have tried various treatments to regain pigment and are not satisfied with the results and/or their white spots are so extensive, they may consider depigmenting. This is a permanent killing-off of melanocytes (which give the skin their color), leading to an all-over white skin. This decision has greater ramifications for those people with darker skin tones, as they may suffer racial identity issues.

The most common method of depigmenting is the use of the prescription cream“Monobenzylether of hydroquinone” which is commonly called “monobenzone” and sold with the brand name “Benoquin.” This drug has one use: to remove remaining pigment in those with extensive vitiligo. It is not to be used for general skin lightening or the removal of freckles or other pigmentary disorders. Again: The sole indication for this drug is for final depigmentation in extensive vitiligo. While Benoquin is sold packaged in tubes with a 20% strength, monobenzone can be compounded to other strengths at a compounding pharmacy or via internet vendors. In any case, this is a prescription drug and should never be misused. Typically, the cream is rubbed into the skin daily, or twice daily, for months, sometimes years. The packaging with Benoquin indicates it is to be used for one to four months, but experience has shown that results take much longer. It is a systemic drug, meaning it will travel throughout the body and remote areas will be affected. The depigmentation generally occurs as a gradual lightening of the skin, not as new spots of vitiligo.

The patient generally begins with a 20% strength cream. Some people will experience a reddish rash and/or dry skin. This can usually be overcome by giving the skin a break in treatment and/or having the cream re-formulated with a different base or lower monobenzone strength. Experience has shown it prudent to avoid rubbing the cream on the face so a rash or dry skin will not be obvious, should that occur. And, most people begin their regimen with spreading the cream on a limited area, such as just the arms or even one arm, until it is certain that it is being tolerated. Once that trial period is over, the doctor might prescribe a higher strength of the cream, such as 30% or 40%. However, depigmentation can be successfully completed even if the patient stays with the 20% strength throughout. Other products that are sold over-the-counter as skin lighteners will not bring about depigmentation, and people who are looking to simply lighten their skin or defects in their skin tone should NOT use monobenzone.

Most doctors follow the guideline that a patient must be at least 50% involved with vitiligo before beginning depigmentation therapy. However, some doctors will prescribe monobenzone for those with lesser amounts of vitiligo if the existing vitiligo is concentrated in visible areas and is causing the patient considerable distress.

Depigmentation is not the same as “skin lightening” or “skin bleaching.” And, monobenzone can not be used to remove pigment selectively from certain parts of the body. Once total depigmentation is achieved the patient will be more susceptible to sunburn and should use sunblock regularly.

People question if, along with skin color, color will be lost from the eyes, naturally darker body areas, or body hair. Depigmentation is not the same as Albinism, but people have various responses to total depigmentation. The eye color is not affected. The lips, mouth, and nipples usually retain their darker tone. Some have seen loss of body hair color, while retaining color in their eyebrows, eyelashes, and on their heads. In fact, it is considered a good sign if body hair is white since pigment can be retained lower in the skin, in the hair follicles, where it may be stimulated (by sun? by chemicals?) to reproduce and create freckles of normal skin tone, even years after total depigmentation. When those hairs turn white, it indicates the pigment no longer exists. In the future, if spots of pigment appear, it will require another regimen of spreading the monobenzone cream on the affected areas for weeks or months to eradicate the new pigment. Using sunblock on exposed skin helps prevent recurrence of pigment. This does not mean you are unable to enjoy sunny days! Just wear a hat and sunblock and enjoy your new freedom from worrying about your skin’s appearance. Some people never experience freckling once they have totally depigmented; rarely, some people have pigment come back in numerous spots much like the reverse of their vitiligo.

Claims that vitiligo or depigmentation leads to greater chance of skin cancer are not true. In fact, a vitiligo expert stated that with the total loss of melanocytes (depigmentation), it would be virtually impossible to get melanoma, the most serious form of skin cancer. Rates of cancer for those with vitiligo are not higher than for those without it.
People worry that they will look ghostly white, seeing the whiteness of their vitiligo as being too extreme. The whiteness produced by depigmentation is not like a white sheet of paper; it is modulated by the blood vessels, hair, and exposure to sun. It is true that the blood vessels may be seen more prominently, particularly on the hands.

It is not advised to use monobenzone if you are pregnant or nursing. Doctors may not wish to prescribe this drug for children, even those with extensive vitiligo. Several countries do not allow the sale of monobenzone; in some cases, patients have managed to get it by mail order or by foreign travel, but a prescription will still be needed. Prescription drug coverage often will NOT cover monobenzone, as some insurance companies consider vitiligo a cosmetic condition, not a medical problem. Patients are advised to get their doctors involved in getting the prescription authorized for reimbursement by the insurer. From time to time, Benoquin becomes unavailable; it is advised that patients keep extra stock on hand to get them through these periods.

[Sources]

http://www.vitiligosupport.org/

http://en.wikipedia.org/wiki/Depigmentation

http://freshaquarium.about.com/od/termsandtables/g/depigmentation.htm