This protocol applies to patients with extensive vitiligo who still have areas of normally pigmented skin and have chosen a depigmentation strategy — specifically, those whose prior topical depigmentation course did not achieve the expected outcome.
Extensive vitiligo has left isolated islands of normal pigmentation. A decision has been made to pursue complete depigmentation to achieve a uniform appearance. Topical depigmenting agents — including monobenzyl ether of hydroquinone (MBEH/monobenzone), 4-methoxyphenol (mequinol), and phenol — represent the initial approach, particularly given their suitability for larger remaining pigmented areas.
The expected benchmark for topical depigmentation is 61%–92% depigmentation at treated sites within approximately 10 months. When this threshold is not met, the protocol escalates to the next treatment line.
Availability of topical agents such as MBEH also varies by country, which can limit first-line options and prompt earlier escalation.
DOI: 10.1111/jdv.19450
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.
Cryotherapy and pigment lasers are the two options for physical depigmentation therapies.
Cryotherapy can achieve rapid depigmentation via irreversible tissue damage, in particular in patients sensitive to Koebner's phenomenon.
Several types of lasers involving wavelengths between 532 and 755 nm targeting pigmentation are also used for depigmentation.
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