Even after we have been unsuccessful in repigmenting their skin with PUVA and topical steroids, patients are sometimes still reluctant to undergo depigmentation. They want to be of one color again, but they fear that they will be too light, that they will burn when they go out in the sun, and that they will not be able to repigment if a cure for vitiligo becomes available in the near future. Additionally, other concerns such as obtaining the medication, allergic reactions due to the depigmenting cream, pigment spots reappearing on the face, extensive repigmentation and even hyperpigmentation occur in a few cases. In spite of all these real difficulties, when one becomes one color, that is totally white, the patient, the families, and the physician have a feeling of great accomplishment. I have never had a patient who was unhappy after being depigmented.
Some patients state that they are now cured.
The key to depigmentation is the topical application of a cream containing monobenzyl ether of hydroquinone, an antioxidant, that has the generic name monobenzone. The most widely used commercial product is called Benoquin that contains 20 percent monobenzone. Other compounds such as hydroquinone simply do not work. It is a shame that moneys from industry and government have not been available to find other com-pounds and other ways to bring about total vitiligo. The major source of Benoquin in the United States has been ICN Pharmaceuticals in Costa Mesa, California.