Hypopigmentation Treatment: Options For White Patches and Scars

There are a whole range of treatment approaches available. Which one is right for you depends greatly on the causes of hypopigmentation. Although it will also be greatly impacted by local availability and the advice of your medical professional.

So these are the treatments for hypopigmentation currently available:-

Topical Hypopigmentation Creams

The most common approach to treating hypopigmentation is to use a cream applied to the affected areas. It’s easy to do, can be done at home and is generally a very cheap option.

There are some very different types of cream to be aware of though.

Steroidal Cream

Corticosteroid creams are a typical first try treatment for vitiligo. But given that the cause of vitiligo is still not very well understood, the results can be unpredictable. So typically a doctor will prescribe corticosteroids on the basis of ‘try it and see how you go’. It may or may not improve the appearance, and if there are no signs of improvement within 2 months then it’s not likely to work.

This needs to done under close supervision of a medical professional. Partly because there are side effects, such as thinning of the skin, that you need to watch out for. And partly because overuse of steroid creams can actually cause hypopigmentation!

Hydroquinone Based Cream

Not a typical approach but this comes under the idea of trying to unify the skins color. Hydroquinone is actually a skin whitening agent, but it has been used to help blend hypopigmented areas in to the skins natural surrounding color. The idea being to lessen the contrast between the two areas.

Hydroquinone does however come with some warnings. There are side effects, and these have been considered significant enough for it’s use to be banned by some countries.

Hydroquinone Free Creams

The same approach as above, but you can now get lightening creams that do not use hydroquinone. These tend to use ingredients like bearberry extract/arbutin, kojic acid or azelaic acid. They have been shown to be just as effective as over the counter products containing hydroquinone but without the known risks.

Depigmentation Therapy

This approach is typically only used in vitiligo cases where more than half the skin surface has been affected. The idea is to remove the remaining pigment and therefore achieve an overall consistent skin color. Of course that skin color is then ‘paper white’ all over the body. Although it is often then ‘toned’ off-white by taking a high dose of beta-carotene.

Most commonly this is achieved using a strong bleaching cream containing monobenzyl ether of hydroquinone (MBEH), which is the only depigmentation treatment that has FDA approval. This is not the same as hydroquinone although it is derived from it. MBEH causes permanent loss of pigment – it actually kills melanocytes (the bodies pigment producing cells). It also affects areas beyond those on which it is applied, which is why it is only used for full depigmentation.

The most commonly used product is Benoquin which contains 20% MBEH.

Microdermabrasion

Microdermabrasion may help to reduce the appearance of some scars, which may themselves be hypopigmented, but it is not really useful as a treatment for hypopigmentation itself.

Dermabrasion is a deeper form of treatment carried out by medical professionals only. This is effective at improving e.g. acne scars. But again it does not really help with loss of pigmentation. It can actually cause skin discoloration for those with darker skins. Microdermabrasion is a much lighter treatment and generally considered safe for dark skins too.

Chemical Peels

Peels are so called because they can make the outer layers of your skin ‘peel away’. This sounds quite dramatic – but it greatly depends on the depth of treatment used. The idea however is to remove the top layers of skin to force the body into making new skin and collagen in it’s place. With the right depth of peel this should remove or at least improve the areas of concern.

Skin peels are generally categorised into superficial, medium and deep peels. The gentler treatments, such as glycolic, AHA or BHA peels, are often used used on the face just to give a fresher brighter appearance. But in terms of hypopigmentation we are really talking about use for scar treatment.

Which type of peel you get depends on the level of scarring you are dealing with. A superficial peel, or a series of them, may be enough to treat mild acne scarring for example. But for more serious scarring there are treatments right up to a deep phenol peel – which are only done under sedation because they can be very uncomfortable and painful. They also have a recovery time of a couple of weeks.

UV Therapy / Phototherapy

Phototherapy is a common and effective treatment for vitiligo. It basically treats the depigmented areas with UV light in a very controlled way using a special lamp.

Combination UV/Drug Therapy

Typically phototherapy is used in combination with a drug that makes your skin more sensitive to UV light. Most commonly the drug psoralen is used, together with ultraviolet A, hence the name of this therapy as PUVA.

Laser Treatments

As with many things, laser therapy can be both ‘cure and cause’. That is, you can sometimes end up with hypopigmented skin following certain laser treatments. In the case of hypopigmentation after laser hair removal for example, this will normally repigment by itself. The problem is it can take months without additional treatment.

Which type of laser treatment is best for you depends on the type of hypopigmentation and/or scarring you want to treat, as well as where it is on the body and how severe it is. You need to get a qualified physician or aesthetician to inspect the area to know the best way to proceed.

Excimer Laser Treatment

Excimer lasers are the same type used in Lasik eye surgery. But they have also been used very effectively for years now in treating hypopigmented scars and stretch marks. A study was done back in 2004 ^[1] which showed a 100% correction in skin color after just 9 treatments. Although a top-up treatment was then needed every 1 to 4 months to maintain the color improvement.

This laser treatment has also been shown to be effective for vitiligo too ^[2], typically only used for facial/neck areas. It is more effective when used with topical steroids.

Fraxel Restore Laser Treatment

Fraxel is actually a brand name for a process known as fractional resurfacing. It has been shown to be effective for mild to moderate acne scarring, as well as other types of scarring.

Natural Treatment Options

Most forms of treatment tend to come with some form of risk or side effects, however minor those may be. And natural solutions are not free of these risks. But some people do prefer to try a more natural approach before considering medically recommended therapies.

Makeup / Skin Camouflage

This is probably the simplest approach of all – you can just cover the affected area with makeup. Skin camouflage makeup is designed for this purpose and therefore lasts a lot longer without needing to be reapplied. Obviously this is more convenient if the area or areas to be covered are not particularly large.

Natural Creams

If you would rather blend than conceal, there are creams without hydroquinone that can help to lighten darker boundaries of hypopigmented skin. This needs to be approached with care, but can make the area stand out less.

Ginkgo Biloba

One study did show that taking a supplement of ginkgo biloba may help with vitiligo. There was evidence of significant improvement, not only in stopping white patches getting worse but also in some recovery of lost skin color. It was a limited study, but was enough to recommend a larger study be carried out as a result.

Surgical

These are fairly major options clearly only used in cases where other options have proven ineffective, or where scarring or hypopigmentation is severe. But it’s worth mentioning them here so you are aware of the possibilities.

Scars can themselves be cut away and removed. This is itself would likely leave a scar, but for severe scarring can be an overall improvement. Or the scar removal could be combined with a skin graft procedure.

Skin Grafting

Skin grafts have long been used to treat areas of severely damaged skin. The approach is to take healthy skin from one area of your body (usually somewhere less visible), and apply it to where it is needed. This is common for burn victims, but can also be used in cases of vitiligo.

Melanocyte Transplant

This is a bit like a skin graft, except the melanocytes (pigment making cells) are extracted from the removed piece of skin. And it is then only the melanocytes that are transplanted into the affected white areas.

Learning To Live With It

This final option is not meant to be flippant. Any kind of blemish can be distressing even if it doesn’t appear that noticeable to other people. The psychological aspects are not to be underestimated.

That said, if you are able to come to terms with scarring or hypopigmentation white spots that you have and accept them as part of you, then life becomes a lot easier. This is easier said than done of course, and depends greatly on where the areas are and the severity.

Sun Protection

Finally, whilst this is a catch 22, do remember that areas of skin with pigment will be more sensitive to UV light. That means they burn more easily. So you need to be more careful of those areas to prevent long term damage.

References

[1] Alexiades-Armenakas, Macrene R., et al. "The safety and efficacy of the 308-nm excimer laser for pigment correction of hypopigmented scars and striae alba." Archives of dermatology 140.8 (2004): 955-960.

[2] Mouzakis, John A., Stephanie Liu, and George Cohen. "Rapid response of facial vitiligo to 308nm excimer laser and topical calcipotriene." The Journal of clinical and aesthetic dermatology 4.6 (2011): 41.