When vitiligo covers a large proportion of the body and repigmentation is no longer the chosen goal, depigmentation of the remaining normally pigmented areas can provide a uniform appearance. This protocol covers the structured approach to that decision.
Extensive vitiligo with residual islands of normally pigmented skin, where the patient and clinician have elected depigmentation as the treatment direction to achieve a consistent skin tone across all affected areas.
The approach centres on topical depigmenting agents applied to the remaining pigmented skin. One agent within this class carries regulatory approval specifically for vitiligo and is particularly well suited to larger areas of residual pigmentation. The complete protocol — including agent selection, the full range of available options, and monitoring guidance — is available via the link below.
Substantial, measurable depigmentation at treated sites, typically achieved over a course of approximately 10 months.
DOI: 10.1111/jdv.19450
Topical depigmenting agents include monobenzyl ether of hydroquinone (MBEH), 4-methoxyphenol (4MP, mequinol or p-hydroxyanisole) and phenol.
MBEH (p-benzyloxy-phenol, monobenzone) is the only topical depigmenting agent that is currently approved for vitiligo by the Food and Drug Administration.
MBEH is better suited for treating larger remaining areas of pigmentation compared to laser and cryotherapy; however, MBEH is not currently available in all countries.
The expected results (61%–92% depigmentation) with 20% MBEH are usually achieved at treated sites after 10 months.
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