Management Strategies for Depigmented Skin

Strategies are available for the treatment of depigmented skin, according to a review study published in the Journal of Cosmetic Dermatology. Depigmented skin provides a considerable burden on the patient’s daily life and is difficult to manage, therefore therapeutic mode of action and depigmentation etiopathogenesis are essential elements when determining the appropriate diagnosis and intervention.

Although some depigmentation disorders are genetic, controllable melanocytotoxic factors include phenols, thermal trauma, ionizing radiation, steroids, and cryogens. The primary treatments for depigmented skin management have various mechanisms of action that should be taken into account when determining optimal intervention for the patient.

Immunomodulators include corticosteroids and Jak-Stat inhibitors, such as factinib, ultraviolet therapy, and vitamin D analogues. They aim to eliminate cytotoxic lymphocytes and should be used to treat destructive immune processes. Spontaneous repigmentation may occur in these cases at the cessation of the destructive process if the affected area has sufficient active precursors within hair follicles or eccrine glands.

Melanocyte protectors include antioxidants, sunscreens, and anxiolytics. These preventative treatments aim to protect melanocytes from external and internal factors and may be used in conjunction with other remedies that are more proactive.

Melanocyte homeostasis activators include ultraviolet therapy, excimer laser, prostaglandin E2, and L-phenylalanine. These treatments can promote the transformation of melanocyte stem cells (MSCs) into new functioning melanocytes and thus should be used in areas with existing melanocyte precursors.

Melanocyte precursor inducers include dermabrasion, laser ablation, and other skin traumatizing remedies. They act by awakening hibernating stem cells, possibly through biostimulation or trauma, and thus should be used in areas with ample melanocyte precursors.

Providers of new melanocyte generations include grafts and cellular suspensions and should be used on localized patches in areas naturally lacking MSCs, with severely mutated populations of melanocyte precursors, or in atrophic skin, such as in cases of segmental or localized vitiligo.

Camouflage, including concealers or foundation makeup creams, is an appropriate option for highly exposed areas such as the fingers or face that are not responding well to treatment.

Depigmenting or removal of very small, isolated areas of pigmentation through monobenzylether of hydroquinone, phenol 88%, Q-switched laser depigmentation, and cryogen depigmentation may be appropriate when depigmentation is generalized and small spots of pigmentation are not preferred.

There are many options for “managing the challenge of depigmented skin” that can appropriately address a patient’s unique issue, depending on the cause, area of concern, reaction to previous treatment, and stability of the disorder, the study author concluded.

Reference

Awad SS. Seven strategies for the management of depigmented skin according to the etiopathogenesis. [published online August 9, 2020]. J Cosmet Dermatol. doi:10.1111/jocd.13631