From the Guidelines
Monobenzone should not be used to repigment vitiligo; it actually does the opposite by depigmenting normal skin. For vitiligo treatment, patients should instead use repigmentation therapies like topical corticosteroids, calcineurin inhibitors, or phototherapy, as supported by the guideline for the diagnosis and management of vitiligo 1. Monobenzone (Benoquin) is specifically used for universal depigmentation in extensive vitiligo cases (>50% body surface affected) where repigmentation is not feasible, as recommended by the British Journal of Dermatology guideline 1. If depigmentation is the goal, patients apply a thin layer of 20% monobenzone cream to remaining pigmented areas twice daily for several months until the skin matches the vitiligo patches. This medication works by permanently destroying melanocytes, making the skin uniformly white. Side effects include skin irritation, contact dermatitis, and increased sun sensitivity. This treatment is irreversible and requires lifelong sun protection, so it should only be used after careful consideration and consultation with a dermatologist specializing in vitiligo management. Some key points to consider when treating vitiligo include:
- The use of phototherapy with NB-UVB has shown good evidence of response in some patients with vitiligo 1
- The superiority of NB-UVB over PUVA has been demonstrated in a single randomized double-blind trial 1
- Maintenance of > 75% repigmentation of surface area was seen in 24% in the PUVA group and 36% in the NB-UVB group 1
- Safety limits for NB-UVB for the treatment of vitiligo should be more stringent than those applied to psoriasis, with an arbitrary limit of 200 treatments for skin types I–III 1
From the Research
Monobenzone Usage for Vitiligo Repigmentation
- Monobenzone is used topically to depigment remaining normally pigmented skin in patients with extensive vitiligo 2.
- However, the provided studies do not offer guidance on using monobenzone for repigmentation, but rather for depigmentation 3, 4.
- Other treatments, such as UVB-targeted phototherapy, have been shown to be effective for repigmentation in patients with vitiligo affecting less than 10% of the body surface area 5.
- Narrow-band ultraviolet B (NB-UVB) phototherapy is also a mainstay treatment for vitiligo, with studies showing significant repigmentation outcomes and persistence of repigmentation after discontinuation of treatment 6.
Important Considerations
- Monobenzone is a potent depigmenting agent, and its use is limited due to its permanent and potent nature 3.
- Candidates for depigmentation therapy, including monobenzone, should be carefully screened, and patient education is essential 4.
- Other treatment options, such as corticosteroids, immunomodulators, and skin grafts, may be considered for repigmentation in patients with vitiligo 5, 6.