A Puneet Group Presentation
LIGHT! DID YOU SAY LIGHT!
THE PATCH LOOKS LOVELY BRIGHT
SOON THE WHITE PATCH
GROWS AND SPREADS
THE SUN MAKES IT
A LITTLE RED,
HOW CAN VITILIGO
HARMLESS, NOT EVEN SKIN DEEP
CAN CAUSE A TRAUMA SO DEEP?
VITILIGO
Chronic skin disease occurring worldwide in about 1% of
the population, mostly between the age of 10-30
 White spots occur when the skin no longer forms melanin
(pigment that determines the color of your skin, hair, and
eyes)
 White patches of irregular shapes begin to appear on skin
 Total absence of melanocytes microscopically

CLINICAL FEATURES
Totally amelanotic macule (patch) surrounded by
normal skin
 Vitiligo macules characteristically have fairly discrete
margins and they are round, oval or linear in shape
 Lesions enlarge centrifugally over time, but the rate
may be slow or rapid
 Vitiligo macule patches ranges from millimeter to
centimeter in size

DISTRIBUTION PATTERN OF VITILIGO
Focal
•a few isolated
lesions
Segmental
•unilateral
distribution
Vulgaris
• fingers and
around mouth
Universal
• total
depigmentation
SUB TYPES OF VITILIGO
Differ by anatomical location, and size of lesions
Focal
• A few isolated lesions, most common in children
Segmental
• Unilateral distribution
Acrofacial
• Fingers and periorificial areas
Universal
• Almost total depigmentation
Mucosal
• Depigmentation of only the mucous membrane
GENERALIZED
• Most common, symmetrical distribution, occurs
symmetrically on both sides of the body
VITILIGO CAUSE- MELANOCYTE DESTRUCTION
1. Stress to the skin in form of
wound, burn, excessive sun
exposure or contact with
bleaching phenol
2. Differential gene expression
among melanocytes
3. Inflammatory infiltrate of T
cells & macrophages
4.
Further induce melanocyte
apoptosis
WHY IS THE TREATMENT IMPORTANT???
Vitiligo - not harmful medically, but emotional
and psychological effects can be devastating.
 Affects self-esteem.
 Women, are sometimes discriminated against in
marriage.
 Developing vitiligo after marriage can be grounds
for divorce.
 People suffering from vitiligo feel embarrassed,
depressed, or worried about other people’s
reaction.

THE PRIMARY GOAL OF VITILIGO
THERAPY IS TO REPIGMENT THE
AFFECTED SKIN. HOWEVER, IT IS
NOT ALWAYS POSSIBLE.
In such cases , depigmentation is the only
available option
WHERE DE-PIGMENTATION THERAPY REQUIRED
Patients with widespread and extensive vitiligo with Body Surface Area(BSA)>50%,
who desire permanent matching of skin colour, and where the probability of achieving
cosmetically significant repigmentation is low. Generally it can be considered if
vitiligo involves more than 60% to 80% of BSA.
Patients with less extensive disease (30-50% BSA) who have progressive disease or
have shown resistance to standard therapies for repigmentation.
Vitiligo extensively involving cosmetically sensitive areas of face and hands where
covering cosmetics are ineffective, although it is unusual to treat only the exposed
sites.
Vitiligo involving areas known to be resistant to treatment, e.g. hands, malar areas.
LIST OF DEPIGMENTING AGENTS
First line
agents
Second line
agents
Experimental
agents
• MONOBENZONE
•88% phenol,
•Laser,
•cryotherapy
•Imatinib
•Imiquimod
•diphencyprone
•Hydroquinone, 4-Ethoxyphenol,4-methylcatechol,
•Catechol,
•IFN-gamma,
•Busulfan,
•Vaccines using melanoma associated antigens etc
COMPOSITION:MONOBENZONE USP…..20% W/W CREAM BASE…………..Q.S.
MONOBENZONE
Monobenzyl ether of hydroquinone (MBEH)
 Chemical Name: P- (Benzyloxy) - Phenol
 Acts as a skin sensitizer
 Topical application decreases the excretion of
melanin from melanocytes in animal
 Depigmentation spreads to distant sites unexposed to
Monobenzone
 Progressive systemic reaction against melanocytes

MECHANISM OF ACTION
TYROSINE
Tyrosinase
MELANOCHROME
MELANIN
MONOBENZONE IS THE MOST
WIDELY USED DEPIGMENTING
AGENT
LIMITATIONS OF OTHER DEPIGMENTING AGENTS
4-Methoxy Phenol
88% Phenol
Different type of lasers
Cyro therapy
Topical Imatinib,
Imiquimod and
Diphencyprone
• Requires longer time prior to the onset of visible
depigmentation
• large areas applications proved to be toxic to
Liver and Kidney.
• Cardiovascular shock, cardiac arrythmias,
bradycardia as well as metabolic acidosis
• Painful & expensive technique
• Available only at hospitals.
• Hospital based treatment.
• It gives edema, pain and bulla formation as side
effects.
• Not suitable for extensive vitiligo
• Require further investigation
EFFICACY OF MONOBENZONE THERAPY
Residual patches of vitiligo affecting
more than 70% of her skin surface
Depigmentation after topical application of
20% Monobenzone daily after 8 months
Pigment Cell Melanoma Res. 22; 42-65. REVIEW ARTICLE Update on skin pigmentation therapies in vitiligo. Rafael Falabella and Maria I.
Barona. Page No. 11
ADMINISTRATION:


Apply a thin layer of
to the normal coloured
skin area which requires depigmentation usually two
to three times daily or as directed by physician. There
is no recommended dose for children under 12 years
of age except under the advice and supervision of a
physician.
It may take up to 4 months before the full benefit of
this drug takes effect. Once the desired skin colour is
achieved, this medication is applied only as needed to
maintain the new skin colour (usually 2 times a
week).Use
cream regularly to get the
most benefit from it. Inform the doctor if your
condition persists or worsens after 4 months.
SIDE EFFECTS OF MONOBENZONE
Mild burning,
 Irritation,
 Redness,
 Cracking, or
 Peeling of the treated skin may occur.
If any of these effects persist or worsen, doctor
needs to be informed.

PRECAUTIONS




This medication is for use on the skin only.
cream should be applied with a patch test for 48 h to
detect hypersensitivity.
Avoid application of
to the eyelids and
areas close to the eye.
Avoid getting this product in your eyes or on the
inside of your nose or mouth. If the cream is
accidentally applied in these areas, flush with plenty
of water.
After using this medication, the skin will be
permanently affected and sensitive to sunlight. Avoid
prolonged exposure to sunlight. Always use
a sunscreen of SPF 15 or greater, and wear protective
clothing when outdoors.
ALBAQUIN TREATMENT EFFECTS

As a depigmenting agent, Monobenzone lightens
up the pigmented areas and matches them with
the white patches arisen out of Vitiligo skin
disorder and can provide following effects to the
patients :

Permanently depigmented skin
 Produce an even tone
 Match the skin around the vitiligo patches to a
uniform light colour
 Create a feeling of normalcy for the patient

BRINGS ABOUT PERMANENT DE PIGMENTATION




Only drug used worldwide as a depigmentation
therapy for vitiligo
Safe and well tolerated
No toxicity to liver or kidney
Permanently lightens skin
IDEAL THERAPY FOR UNIFYING SKIN COLOUR
FOR FURTHER DETAILS CONTACT
PUNEET LABORATORIES PVT.LTD.
605 Raheja Plaza , B wing,
LBS Road, Ghatkopar (West),
Mumbai 400086, India.
TEL. 91-22-61367000
Division Head :
Mrs. Rashmi Jain
Customer Care : 18002096261
E-MAIL : customercare@puneetlabs.com
VISIT US AT: www.albaquin.com