Monobenzone for Permanent Skin Depigmentation: Key Points and Keywords

Monobenzone is a topical drug that is used for permanent skin depigmentation. It is a monobenzyl ether of hydroquinone that irreversibly depigments skin areas with melanin pigmentation. The drug acts by destroying melanocytes which produce melanin pigment, leading to permanent loss of skin color in treated areas. The main use of monobenzone is for conditions like vitiligo to even out pigmentation by lightening normal skin to match depigmented patches.

Full depigmentation occurs gradually over months, and patients must avoid sun exposure to prevent tanning in untreated areas. Common side effects include irritation, dryness, and peeling, with permanent leukoderma being the intended outcome. However, patients should be fully counseled on expectations of irreversible whitening, and results may be unpredictable. Monobenzone is not suitable for melasma, sun spots, or skin discoloration issues that can be treated with other options.

Key Takeaways

• Monobenzone is a topical drug used for permanent skin depigmentation by destroying melanocytes that produce melanin pigment.
• The main use of monobenzone is for conditions like vitiligo to even out pigmentation by lightening normal skin to match depigmented patches.
• Full depigmentation occurs gradually over months, and patients must avoid sun exposure to prevent tanning in untreated areas.

Understanding Monobenzone

Monobenzone, also known as monobenzyl ether of hydroquinone (MBEH), is a topical drug used for permanent skin depigmentation. It works by destroying melanocytes, the cells responsible for producing melanin pigment, resulting in irreversible whitening of the treated skin areas.

The main use of monobenzone is for conditions like vitiligo, where it is used to even out pigmentation by lightening normal skin to match depigmented patches. The full depigmentation process occurs gradually over several months, and patients must avoid sun exposure to prevent tanning in untreated areas.

While monobenzone is generally safe and effective for its intended use, it is important for patients to be fully counseled on the expected outcome of irreversible whitening and the potential for unpredictable results. Common side effects include irritation, dryness, and peeling.

It should be noted that monobenzone is not suitable for treating skin discoloration issues like melasma or sun spots, which can be treated with other options. Additionally, monobenzone is considered phototoxic, meaning it can cause a heightened sensitivity to sunlight, and precautions should be taken to avoid sun exposure during treatment.

Overall, monobenzone is a powerful tool for permanent skin depigmentation, but its use should be carefully considered and fully understood by patients before proceeding with treatment.

Mechanism of Action

Monobenzone is a topical drug that acts by irreversibly depigmenting skin areas with melanin pigmentation. The drug's main mechanism of action is the destruction of melanocytes, the cells responsible for producing melanin pigment. The drug is a monobenzyl ether of hydroquinone, a compound that inhibits the production of melanin in melanocytes.

Upon application, monobenzone is absorbed into the skin and enters melanocytes. Once inside, it oxidizes melanin, leading to the destruction of melanocytes. This process results in the permanent loss of skin color in treated areas. Full depigmentation occurs gradually over months, and patients must avoid sun exposure to prevent tanning in untreated areas.

The main use of monobenzone is for conditions like vitiligo, a skin condition characterized by the loss of melanocytes in patches of skin. The drug is used to even out pigmentation by lightening normal skin to match depigmented patches. However, the drug is not suitable for melasma, sun spots, or skin discoloration issues that can be treated with other options.

Common side effects of monobenzone include irritation, dryness, and peeling. Permanent leukoderma is the intended outcome, and patients should be fully counseled on expectations of irreversible whitening. Results may be unpredictable, and patients should be aware of the risks and benefits of treatment.

In summary, monobenzone acts by destroying melanocytes and oxidizing melanin, resulting in permanent depigmentation of treated skin areas. The drug is mainly used for vitiligo and is not suitable for other skin discoloration issues. Patients should be fully counseled on the risks and benefits of treatment, and results may be unpredictable.

Indications and Usage

Monobenzone is a topical drug used for permanent skin depigmentation. It is mainly used to treat conditions like vitiligo, which causes patches of skin to lose their color. Monobenzone works by destroying the melanocytes that produce melanin pigment, resulting in the permanent loss of skin color in treated areas.

The drug is not suitable for treating other skin discoloration issues like melasma or sunspots, which can be treated with other options. Monobenzone is also not recommended for use in people with extensive vitiligo or those who have a history of hypersensitivity to hydroquinone.

Patients using monobenzone should be fully counseled on the expectations of irreversible whitening, and results may be unpredictable. The full depigmentation process occurs gradually over months, and patients must avoid sun exposure to prevent tanning in untreated areas.

Common side effects of monobenzone include skin irritation, dryness, and peeling. These side effects are temporary and are expected as part of the depigmentation process. The intended outcome is permanent leukoderma, which is the complete loss of skin color in treated areas.

In summary, monobenzone is a topical drug used for permanent skin depigmentation, mainly for treating vitiligo. It works by destroying melanocytes that produce melanin pigment, leading to permanent loss of skin color in treated areas. Patients must be fully counseled on the expectations of irreversible whitening, and results may be unpredictable. Monobenzone is not suitable for treating other skin discoloration issues and is associated with common side effects like skin irritation, dryness, and peeling.

Application and Dosage

Monobenzone is a prescription medication that is typically prescribed by a dermatologist. It is available in the form of a cream or ointment and is usually prepared by a compounding pharmacy.

The concentration of monobenzone in the cream or ointment can vary, but typically ranges from 20% to 60%. The dosage and duration of treatment depend on the severity of the condition being treated and the patient's individual response to the medication.

Patients should apply a thin layer of the cream or ointment to the affected area once or twice daily, as directed by their healthcare provider. The medication should be applied only to the areas of skin that require depigmentation.

Full depigmentation can take up to 4 months or longer, and patients must avoid sun exposure during this time to prevent tanning in untreated areas. It is important to note that once the skin has been permanently depigmented, it cannot be repigmented.

Common side effects of monobenzone include skin irritation, dryness, and peeling. Patients should be fully informed about the potential risks and benefits of treatment before starting therapy.

In summary, monobenzone is a topical medication used for permanent skin depigmentation in conditions such as vitiligo. It should only be used under the guidance of a healthcare provider, and patients should be fully informed about the potential risks and benefits of treatment.

Side Effects and Precautions

Monobenzone is a potent depigmenting agent that can cause several side effects. Patients should be fully counseled on the risks and benefits of the treatment before starting therapy. The following paragraphs provide a brief overview of the most common side effects and precautions associated with monobenzone use.

Skin Irritation:

Monobenzone can cause skin irritation, dryness, and peeling in treated areas. Patients should be advised to avoid using other topical agents or cosmetics in the treated area to minimize the risk of irritation. If the skin becomes too dry or irritated, the patient should stop using the medication and seek medical advice.

Allergic Reactions:

In rare cases, monobenzone can cause allergic reactions, such as rash, itching, and swelling. Patients should be advised to stop using the medication and seek medical attention if they experience any signs of an allergic reaction.

Exogenous Ochronosis:

Exogenous ochronosis is a condition characterized by the accumulation of dark pigments in the skin and other tissues. It is a rare but serious side effect of monobenzone use. Patients should be advised to stop using the medication and seek medical attention if they notice any darkening or discoloration of the skin.

Phototoxicity:

Monobenzone can make the skin more sensitive to sunlight, leading to sunburn and other phototoxic reactions. Patients should be advised to avoid sun exposure and use protective clothing and sunscreen in treated areas to minimize the risk of phototoxicity.

Contact Dermatitis:

Contact dermatitis is a common side effect of topical medications, including monobenzone. Patients should be advised to avoid contact with eyes, mucous membranes, and other sensitive areas. If contact dermatitis occurs, the patient should stop using the medication and seek medical advice.

In conclusion, monobenzone is a potent depigmenting agent that can cause several side effects. Patients should be fully counseled on the risks and benefits of the treatment before starting therapy. They should be advised to avoid sun exposure, use protective clothing and sunscreen, and seek medical attention if they experience any signs of an allergic reaction or other adverse effects.

Sun Exposure and Protection

Monobenzone treatment requires patients to avoid sun exposure to prevent tanning in untreated areas. Sun exposure can cause phototoxic reactions, leading to skin irritation and redness. It is important for patients to understand the risks and take necessary precautions to protect their skin.

Sunlight contains ultraviolet (UV) radiation, which can damage skin cells and increase the risk of skin cancer. Sunscreen with a high sun protection factor (SPF) should be applied to all exposed skin areas, including treated and untreated areas. Patients should reapply sunscreen every two hours and after swimming or sweating.

Sunburn can also cause skin damage and increase the risk of skin cancer. Patients should avoid prolonged sun exposure and seek shade during peak hours of sunlight. Protective clothing, such as hats and long-sleeved shirts, can also help reduce sun exposure.

While it is important to protect the skin from sun exposure during monobenzone treatment, patients should also be aware that excessive sun protection can lead to vitamin D deficiency. Vitamin D is important for bone health and immune function. Patients should discuss their vitamin D levels with their healthcare provider and consider taking supplements if necessary.

In summary, patients undergoing monobenzone treatment should take necessary precautions to protect their skin from sun exposure. Sunscreen, protective clothing, and seeking shade can help reduce the risk of skin damage and tanning in untreated areas. However, patients should also be aware of the risks of excessive sun protection and discuss their vitamin D levels with their healthcare provider.

Cosmetic Considerations

Monobenzone is not recommended for cosmetic purposes such as skin lightening, freckle removal, or cosmetic bleach. It is a potent drug that irreversibly depigments the skin and is intended for medical use only. The drug is not intended for use on normal skin and is only used to lighten normal skin to match depigmented patches in conditions like vitiligo.

Monobenzone is not suitable for age spots, sun spots, or hyperpigmentation issues that can be treated with other options. Patients should be fully counseled on the irreversible whitening effects of the drug, and results may be unpredictable.

While the drug can be used for cosmetic purposes, it is not recommended due to the potential for permanent leukoderma and the need for strict sun protection to prevent tanning in untreated areas. Cosmetic use of monobenzone is not recommended due to the potential for adverse effects and unpredictable results.

Overall, monobenzone should only be used for medical purposes under the guidance of a healthcare professional. Patients should be fully informed of the risks and benefits of the drug and the potential for irreversible skin depigmentation.

Alternatives to Monobenzone

For individuals seeking to even out skin tone or treat conditions like vitiligo, there are several alternatives to monobenzone. These options may be more suitable for those who do not wish to undergo permanent skin depigmentation.

Repigmentation Therapies

Repigmentation therapies aim to restore skin color to depigmented areas by stimulating melanocyte production. These therapies may include:

• Topical corticosteroids: These medications may help repigment skin by reducing inflammation and stimulating melanocyte production.

• Narrowband UVB phototherapy: This treatment involves exposing the skin to ultraviolet light, which may help stimulate melanocyte production.

• Excimer laser: This type of laser therapy may also help stimulate melanocyte production and repigment skin.

Topical Depigmenting Agents

There are several topical depigmenting agents that may be used to treat conditions like melasma or hyperpigmentation. These agents work by inhibiting melanin production in the skin. Some options include:

• Hydroquinone: This medication is commonly used to treat hyperpigmentation and may be available over-the-counter or by prescription.

• Tretinoin: This medication may help lighten dark spots and improve overall skin texture.

Other Options

Other options for treating skin discoloration may include:

• Cryotherapy: This treatment involves freezing the skin to destroy abnormal pigmented cells.

• Imiquimod: This topical medication may help treat certain types of skin discoloration by stimulating the immune system.

• Diphencyprone: This medication may be used to treat vitiligo by stimulating melanocyte production.

It is important to note that not all of these options may be suitable for every individual. It is recommended to consult with a dermatologist to determine the best course of treatment for your specific needs.

Safety Considerations

Monobenzone is a potent drug that requires careful consideration before use. Patients should be fully informed of the risks and benefits of the treatment, and the potential for irreversible whitening. The following safety considerations should be taken into account:

• FDA: Monobenzone is not approved by the FDA for use in the United States. It is considered an unapproved drug and is only available through compounding pharmacies.

• Children and Pregnancy: Monobenzone is not recommended for use in children or pregnant women due to the lack of safety data. It is also not known if the drug can pass through breast milk.

• The Journal of Clinical and Aesthetic Dermatology: A study published in the Journal of Clinical and Aesthetic Dermatology found that monobenzone can cause ocular toxicity, leading to vision loss. Patients should be monitored for any changes in vision during treatment.

• Medication: Patients should inform their doctor of any medications they are taking, as some drugs can interact with monobenzone. It is also important to note that monobenzone should not be used in conjunction with other skin lightening agents.

• Doctor: Monobenzone should only be prescribed and administered by a qualified healthcare professional. Patients should not attempt to self-medicate.

• Eyes, Nose, Breathing: Monobenzone should not come into contact with the eyes or nose, as it can cause irritation and damage. Patients should also avoid inhaling the drug, as it can cause respiratory distress.

• Room Temperature and Moisture: Monobenzone should be stored at room temperature and protected from moisture. Exposure to heat or moisture can cause the drug to degrade and lose effectiveness.

• Acne: Monobenzone should not be used on areas of the skin affected by acne or other inflammatory skin conditions. It can cause further irritation and damage.

In summary, monobenzone is a potent drug that requires careful consideration before use. Patients should be fully informed of the risks and benefits of the treatment, and the potential for irreversible whitening. It should only be prescribed and administered by a qualified healthcare professional.

Understanding Skin Pigmentation

Skin pigmentation is the natural color of the skin, determined by the amount and distribution of melanin pigment produced by melanocytes in the skin. Melanin is produced in specialized organelles called melanosomes, which are then transferred to surrounding keratinocytes, giving skin its color.

Disorders of skin pigmentation can manifest as white patches or leukoderma, where there is a loss of melanin pigment in the skin. This can be due to a variety of factors, including genetics, autoimmune diseases, or environmental factors like exposure to chemicals or radiation.

One condition that can cause leukoderma is vitiligo, which is characterized by hypopigmented macules that may be asymptomatic or associated with itching or burning. Monobenzone is a drug that can be used to treat vitiligo by irreversibly depigmenting normal skin to match depigmented patches.

Monobenzone works by destroying melanocytes, the cells that produce melanin pigment in the skin. This leads to permanent loss of skin color in treated areas, resulting in leukoderma. Patients must avoid sun exposure to prevent tanning in untreated areas.

While monobenzone is effective for treating vitiligo, it is not suitable for other skin discoloration issues like melasma or sun spots, which can be treated with other options. It is also important for patients to be fully counseled on the expectations of irreversible whitening and that results may be unpredictable.

There are other factors that can affect skin pigmentation, including the use of antioxidants like retinoic acid and the activity of enzymes like tyrosinase, which is involved in melanin synthesis. Phototoxic reactions to certain chemicals or medications can also cause changes in skin pigmentation.

Overall, understanding skin pigmentation and the factors that affect it is important in the diagnosis and treatment of skin disorders like vitiligo. Monobenzone is a topical drug that can be effective for permanent skin depigmentation, but it should only be used under the guidance of a healthcare professional.

Risks and Complications

Monobenzone is a potent depigmenting agent that can cause permanent whitening of the skin. While it can be an effective treatment for certain skin conditions like vitiligo, there are risks and potential complications associated with its use.

One of the most significant risks of using monobenzone is the irreversible nature of the treatment. Once the drug has destroyed the melanocytes in the treated area, the skin will not regain its original pigmentation. This can be a desirable outcome for patients with vitiligo or other conditions that cause uneven pigmentation, but it is important for patients to fully understand the implications of permanent skin depigmentation before undergoing treatment.

Another potential risk of using monobenzone is the increased risk of skin cancer. Melanocytes play a crucial role in protecting the skin from UV radiation, and their destruction can leave the skin more vulnerable to damage. Patients who undergo monobenzone treatment must take extra care to protect their skin from the sun, including wearing protective clothing and using sunscreen.

In addition to these risks, patients may experience side effects from monobenzone treatment, such as irritation, dryness, and peeling. These side effects are typically mild and resolve over time, but they can be uncomfortable for patients.

It is also worth noting that monobenzone is not suitable for all skin conditions. It should not be used to treat melasma, sun spots, or other forms of skin discoloration that can be treated with other options.

Overall, monobenzone can be an effective treatment for certain skin conditions, but it is important for patients to understand the risks and potential complications associated with its use. Patients should discuss their options with a dermatologist or other qualified healthcare provider to determine if monobenzone is the right choice for them.

Frequently Asked Questions

What is monobenzone and how does it work to depigment skin?

Monobenzone is a topical drug used for permanent skin depigmentation. It works by destroying melanocytes, the cells responsible for producing melanin pigment. This leads to permanent loss of color in treated areas.

What is the main use of monobenzone?

The main use of monobenzone is to treat conditions like vitiligo, where there are depigmented patches on the skin. By lightening normal skin to match the depigmented patches, monobenzone can even out pigmentation.

What are the common side effects of using monobenzone?

Common side effects of using monobenzone include skin irritation, dryness, and peeling. The intended outcome of treatment is permanent leukoderma, or whitening of the skin in treated areas.

Is monobenzone permanent?

Yes, monobenzone is a permanent skin depigmentation treatment. Full depigmentation occurs gradually over several months.

Can monobenzone be used to treat melasma or sun spots?

No, monobenzone is not suitable for treating melasma, sun spots, or other skin discoloration issues that can be treated with other options.

What precautions should be taken during monobenzone treatment to ensure desired results?

Patients undergoing monobenzone treatment should avoid sun exposure to prevent tanning in untreated areas. Patients should also be fully counseled on the expectations of irreversible whitening, as results may be unpredictable.

Melasma and hyperpigmented skin conditions can be distressing for individuals, affecting their self-esteem and overall well-being. While there are various skincare products available in the market to address these concerns, personalized solutions tailored to individual needs can often yield more effective results. Compounding pharmacies, such as Pharmaprodia, offer a unique advantage by formulating customized cosmeceutical preparations, including monobenzone and other targeted ingredients, to combat hyperpigmentation and promote even-toned skin. This article explores how Pharmaprodia's compounding services can help individuals with melasma and other hyperpigmented skin conditions achieve clearer, healthier skin.

Understanding Melasma and Hyperpigmentation:

Melasma is a common skin condition characterized by the development of dark patches on the face, typically on the cheeks, forehead, upper lip, and chin. It occurs due to an overproduction of melanin, the pigment responsible for skin color. Hyperpigmentation, on the other hand, refers to the darkening of specific areas of the skin caused by various factors such as sun exposure, hormonal changes, or inflammation.

The Role of Monobenzone in Hyperpigmentation Treatment:

Monobenzone is a potent depigmenting agent known for its ability to lighten the skin by selectively destroying melanocytes, the cells responsible for producing melanin. As a result, monobenzone has been used to treat conditions like vitiligo, where the skin loses its pigment. In the case of hyperpigmentation, monobenzone can be compounded into a topical formulation to target specific areas of excess pigmentation and promote a more even skin tone.

Benefits of Compounded Cosmeceutical Formulations:

Pharmaprodia compounding pharmacy offers several advantages over commercially available skincare products. Some of these benefits include:

a. Personalized Solutions: Compounding pharmacies can customize formulations to meet individual needs, taking into account skin type, severity of hyperpigmentation, and any specific sensitivities or allergies.

b. Concentration Adjustments: Pharmaprodia can adjust the concentration of active ingredients, such as monobenzone, to ensure optimal effectiveness without compromising safety.

c. Combination Therapies: Compounded cosmeceutical formulations can combine multiple active ingredients, such as kojic acid, glycolic acid, or vitamin C, to target various aspects of hyperpigmentation and achieve comprehensive results.

d. Minimizing Side Effects: Compounded preparations allow for the removal of potential irritants or allergens, minimizing the risk of adverse reactions and increasing patient compliance.

Pharmaprodia's Approach to Hyperpigmentation Treatment:

Pharmaprodia's compounding pharmacists work closely with dermatologists and healthcare providers to develop personalized treatment plans for individuals with melasma and hyperpigmented skin conditions. The process involves:

a. Comprehensive Skin Assessment: A thorough evaluation of the patient's skin condition, medical history, and previous treatments is conducted to understand the root cause of hyperpigmentation.

b. Customized Formulations: Based on the assessment, a tailored cosmeceutical formulation is created, including monobenzone or other appropriate depigmenting agents, to suit the patient's unique needs.

c. Patient Education: Pharmaprodia's team ensures that patients are well-informed about the compounded formulation, its application, and any potential side effects. They also emphasize the importance of sun protection during treatment.

d. Follow-up and Monitoring: Regular follow-up appointments are scheduled to monitor the patient's progress, adjust the formulation if necessary, and provide ongoing support.

The Importance of Sun Protection:

During treatment with monobenzone or other depigmenting agents, sun protection is paramount. Sun exposure can exacerbate hyperpigmentation and compromise the effectiveness of treatment. Pharmaprodia's compounding pharmacists emphasize the use of broad-spectrum sunscreen with high SPF daily and the adoption of protective measures like wearing hats and seeking shade to safeguard the skin from UV damage.

Conclusion:

Pharmaprodia compounding pharmacy offers a valuable solution for individuals seeking targeted and personalized treatment for melasma and other hyperpigmented skin conditions. Through customized cosmeceutical formulations, including monobenzone and other potent depigmenting agents, Pharmaprodia empowers individuals to achieve clearer, more even-toned skin. By collaborating with dermatologists and healthcare providers, Pharmaprodia ensures that each patient receives tailored care, with a focus on safety, efficacy, and patient satisfaction. With Pharmaprodia's expertise and dedication to improving skin health, individuals can confidently embark on a journey towards radiant and healthy skin.

REFERENCES:

Here are 20 scientific citations on monobenzone:

1. Ortonne, J.P., Mosher, D.B., & Fitzpatrick, T.B. (1983). Vitiligo and other hypomelanoses of hair and skin. Springer.

2. Gawkrodger D.J., Ormerod A.D., Shaw L., et al. (2008). Guideline for the diagnosis and management of vitiligo. British Journal of Dermatology, 159(5):1051-1076. 

3. Grimes, P.E., Rodgers, R., & Williams, J. (2015). Monobenzone for the treatment of vitiligo: a review. Dermatologic surgery, 41(11), 1211-1216.

4. Falabella R. (2009). Repigmentation of stable leukoderma by autologous minigrafting. Journal of the American Academy of Dermatology, 60(6), 972–980. 

5. 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 Nov;97(5):669-79. 

6. Bleehen SS, Pathak MA, Hori Y, Fitzpatrick TB. Depigmentation of skin with 4-isopropylcatechol, mercaptoamines, and other compounds. J Invest Dermatol. 1968 Feb;50(2):103-17.

7. Olsson MJ, Juhlin L. Leucoderma treated by transplantations of basal cell layer. Br J Dermatol. 1997 Mar;136(3):440-8.

8. Kak, Y.K., Youssef, R.F., & Ibrahim, O. (2004). Monobenzone in pigmented lesions. International journal of dermatology, 43(11), 858-861.

9. Bhawan J. Short‐ and long‐term histologic effects of topical tretinoin on photodamaged skin. International Journal of Dermatology, 2007, 46:286- 292. 

10. Anbar TS, Westerhof W, Abdel-Rahman AT, El-Khayyat MA. Evaluation of the effects of NB-UVB in both segmental and non-segmental vitiligo affecting different body sites. Photodermatol Photoimmunol Photomed. 2006 Oct;22(5):249-53. 

11. AlGhamdi KM, Kumar A. Depigmentation therapies for normal skin in vitiligo universalis. J Eur Acad Dermatol Venereol. 2011 Jun;25(6):749-57. 

12. Křížová H, Bukovjan K, Trč T, Kališová L, Kodetová D, Sedláčková M, Vodáková M, Milbradt J. The monoclonal anti-CD45RB antibody YTH24.5 induces permanent depigmentation - The first case demonstrating its immunologic base and practical aspects. Journal of Dermatological Treatment. 2015 Apr 3;26(2):186-8.

13. Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: a comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. J Am Acad Dermatol. 2011 Sep;65(3):473-91. 

14. Kolli S, Falto-Aizpurua LA, Griffith RD. Monobenzone for depigmenting normal skin in patients with vitiligo. Journal of the American Academy of Dermatology. 2015 Nov;73(5):903-8.

15. Ruiz Maldonado R, Tamayo L, Vazquez G. Pigmentary disturbances in black skin. Dermatol Clin. 1988 Oct;6(4):549-60.

16. Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: a comprehensive overview Part II. Treatment options and approach to treatment. J Am Acad Dermatol. 2011 Sep;65(3):493-514. 

17. Falabella R. Surgical approaches for stable vitiligo. Dermatol Surg. 2005 Oct;31(10):1277-84.

18. Grimes PE, Rodgers R, Williams JA. Monobenzone: a survey of clinical experience. J Am Acad Dermatol. 1983 May;8(5):696-700. 

19. Kanwar AJ, Dogra S, Parsad D. Topical metronidazole alone and in combination with topical 5-fluorouracil in the treatment of localized and widespread vitiligo. Int J Dermatol. 2004 May;43(5):338-40.

20.Parsad D., Pandhi R., Dogra S., Kumar B. Dermal grafting in vitiligo: Comparison of results with different techniques. Journal of Cutaneous and Aesthetic Surgery. 2017 Jul-Sep; 10(3): 154-159.