Question 13. Depigmentation: when and how?

Key points

  • If, after consistent treatment(s) for vitiligo, satisfactory repigmentation is not achieved, one can consider depigmentation to avoid the skin color contrast.
  • Chemicals, such as hydroquinone and monobenzone, have been used as topical agents, with increasing doubts as for their safety profile.
  • Many types of lasers (including Q-switched, alexandrite and Ruby Laser) have been used successfully alone or in combination with topical chemical depigmentary agents.
  • Cryotherapy has been used with promising results, but pigment recurrence is always possible.

Depigmentation is an option for vitiligo management that can be used when all repigmentation treatments have failed. The scope of cutaneous depigmentation is to reach a uniform (white or very fair) skin color.

Depigmentation is a process that destroys the remaining cutaneous melanocytes in the skin: patients should be aware that they will stay for the rest of their life with the skin that is not “their own skin”. It may happen that one cannot cope with extreme photosensitivity.

The ideal candidates for depigmentation are adult patients with few residual dark spots scattered over the face or on other visible areas of the body.
Children should not be considered eligible for depigmentation treatments.

Author: Prof. Torello Lotti, MD

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