Depigmentation Treatment Options

In detail…

Depigmentation, as a medical treatment, is the intentional destruction of melanocytes in the skin. This is usually done when all other vitiligo treatments have been unsuccessful and the person desires an even skin tone.

Melanocyte– a mature melanin-forming cell, especially in the skin. (Pronunciation – meh·luh·now·sait)

Melanin – a dark brown to black pigment occurring in the hair, skin, and iris of the eye in people and animals. It is responsible for tanning of skin exposed to sunlight. (Pronunciation- meh·luh·nuhn)

Definitions from Oxford Languages


Depigmentation Treatment Options

Topical agents that depigment normal skin include hydroquinone and monobenzone.

Their mechanism of action is not entirely clear, but studies have shown that both induce melanocyte death.


  • Depigmentation is usually obtained after 1–4 months of treatment.
  • Up to 1-2 years to reach complete body depigmentation
  • When the desired degree of depigmentation is obtained, monobenzone should be applied as often as needed to maintain depigmentation (usually only two times weekly).

In a clinical study of patients with severe vitiligo, monobenzone 20% produced depigmentation in 84% of patients, with complete depigmentation in 44%.

Monobenzyl ether of hydroquinone (MBEH)

  • Monobenzone ethyl ester (MBEH) is a derivative of hydroquinone (HQ).
    It is applied topically as a 20% cream.
  • Approved by the FDA for the treatment of vitiligo.
  • Indicated for extensive ( 50-80%) and refractory vitiligo that failed all other traditional treatments for vitiligo.
  • Unlike HQ, MBEH almost always causes nearly irreversible depigmentation.

Application of MBEH

  • Starts with localized body parts or areas.
    Application advances to other areas as the desired level of depigmentation are reached.
  • A thin layer of cream is applied uniformly and rubbed into the pigmented area.
    Usually 2-3 times per day, but check with your medical professional prior to use.
  • Prolonged exposure to sunlight should be avoided during treatment.
    A sunscreen should be used, as exposure to sunlight reduces the depigmenting effect.

Q Switched Ruby Laser

  • Q-switched laser pulses are applied directly to the pigmented area.
    The skin cells containing melanin absorb the intense laser energy, heat up, and degenerate.
  • The surrounding skin tissue is unharmed.
  • After treatment, as the area heals, the immune system flushes away the dead skin cells and reveals lighter skin.


  • Procedure time depends on the size of the area treated.
  • Patients may experience slight discomfort during the procedure, but the side effects are minimal.
  • Complete pigment removal can be achieved after an adequate number of sessions. Some areas may take a single treatment to remove – others can take six or more treatments, depending on a variety of factors.


Depigmentation Treatment Options

The Q-switched ruby laser

The Q-switched 755 nm



  • Alikhan, A., et al. (2011). “Vitiligo: a comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up.” J Am Acad Dermatol 65(3): 473-491.
  • Felsten, L. M., et al. (2011). “Vitiligo: a comprehensive overview Part II: treatment options and approach to treatment.” J Am Acad Dermatol 65(3): 493-514.
  • Taieb, A., et al. (2013). “Guidelines for the management of vitiligo: the European Dermatology Forum consensus.” Br J Dermatol 168(1): 5-19.
  • Rao J, Fitzpatrick RE. Use of the Q-switched 755-nm alexandrite laser to treat recalcitrant pigment after depigmentation therapy for vitiligo. Dermatol Surg. 2004 Jul;30(7):1043-5. doi: 10.1111/j.1524-4725.2004.30313.x. PMID: 15209798.
  • Majid, I., Imran, S. Depigmentation with Q-switched Nd:YAG laser in universal vitiligo: a long-term follow-up study of 4 years. Lasers Med Sci 32, 851–855 (2017).
  • (Mosher DB, Parrish JA, Fitzpatrick TB. Monobenzylether of hydroquinone. A retrospective study of treatment of 18 vitiligo patients and a review of the literature. Br J Dermatol 1977;97:669-79.)
  • AlGhamdi KM, Kumar A. Depigmentation therapies for normal skin in vitiligo universalis. J Eur Acad Dermatol Venereol. 2011 Jul;25(7):749-57. doi: 10.1111/j.1468-3083.2010.03876.x. Epub 2010 Nov 4. PMID: 21054565.

Text from this page is adapted, with permission, from the Henry Ford Hospital.

A special thank you to Mohammed Aljamal, MD; Fellow of Henry Ford Hospital in Photomedicine, Laser, and Pigmentary disorders.