Monobenzone is still the main culprit of chemical vitiligo
Abstract
Background  Chemical vitiligo is a special variant of vitiligo where the destruction of melanocytes occur at the basal layer of the epidermis and it is initiated by phenolic chemicals either part of industrial contamination of workers or during the course of using monobenzone as a topical depigmenting agent.  Objective To report and evaluate all patients with chemical vitiligo and to delineate the different triggering factors.  Methods This is a case series descriptive study where all patients with chemical vitiligo were gathered during the time from 2014-2021 years. A careful history and full examination were carried including the history of facial chemical exposure and other triggering offending agents. Woods light examination was applied to confirm the clinical diagnosis. All patients with facial leukoderma were treated by topical methoxsalen 1% lotion followed by sunlight exposure (3 times weekly) combined with topical mometasone furoate ointment 0.1% daily and pimecrolimus cream 1% at night for two months.  Results Thirty-two patients were seen with chemical vitiligo, their ages ranged from 20 -50 with a mean of 35 years, with twenty-three (71.8%) females and nine (28.2%) males. Topical monobenzone was applied for 18 (56.25%) patients for the treatment of facial pigmentation mainly for melasma and some cases for lichen planus actinicus. The white areas appeared after 3-6 months of monobenzone cream use. While six (18.75%) cases followed black hair dying and four (12.50%) patients with unknown causes as used multiple cosmetic procedures. Also, one (3.12%) patient gave a history of using rubber sandals that induced contact dermatitis that was followed by chemical vitiligo on the dorsa of both feet. One (3.12%) female patient had linear depigmentation along the leg that followed a triamcinolone intralesional injection of the heel. In addition, one (3.12%) patient had a history of laser used for melasma. While in one (3.12%) patient, his problem followed multiple intralesional triamcinolone injections for melasma. All 31 patients with facial leukoderma showed confetti-like depigmentation of the face but no distant metastatic leukoderma was revealed. These patients with facial leukoderma responded very well to their treatment.  Conclusion Chemical vitiligo is still a medical problem that is commonly induced by the topical application of monobenzone as therapy for melasma. Black hair dying was reported for the first time as a cause of chemical vitiligo. These patients often present with confetti-like depigmentation. ÂReferences
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