What Is It?

Vitiligo with all its social implications can be a devastating disease. Mottled skin in any nationality especially in the cosmetically sensitive areas on the face, hands and visible extremities can mentally scar a patient just as badly as they are physically marked.

Repigmenting treatments such as non-permanent depigmenting agents, oral psoralen plus ultraviolet A (PUVA) and ultraviolet B (UVB) light therapy, and topical immunotherapy with squaric acid dibutyl ester (SADBE) have all been used with varying degrees of success. Long-lasting cosmetic coverage using Custom Color, Dermablend and other masking cosmetics can provide an effective means of camouflage but have drawbacks in terms of prolonged physical activity and social acceptance, especially in men afflicted with this disease.

Permanent depigmentation with monobenzyl ether of quinone (Benoquin, ICN Pharmaceuticals, Costa Mesa, California) has been used for many years and offers homogeneity of skin color with ease of use and little systematic side effects. It is meant to restore a person to one color, if not the patient's natural color. Loss of the skin pigment barrier against the carcinogenic potential of UVB is of major concern and requires life-long avoidance of sun-exposure and correct and frequent use of sunscreens and sun-protective clothing and behavior. In the last ten years increased pubic awareness of melanoma and non-melanoma skin cancer has brought about the development of specially designed UVB-blocking clothing, which may further increase the time between permanent depigmentation and the advent of significant actinic damage and skin cancer. It is a last resort for vitiligo sufferers, and should only be undertaken after all reasonable therapies have been exhausted.

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