Corneal and Conjunctival Effects of Monobenzone in Patients With Vitiligo

Hedges, Thomas R.; Kenyon, Kenneth R.; Hanninen, Laila A.; Mosher, David B.

doi:10.1001/archopht.1983.01040010066010

Cited by 35 publications

(9 citation statements)

References 14 publications

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“…Exogenous ochronosis (caused by local contact to a causative agent like resorcinol, hydroquinone, mercury, phenol, picric acid) has to be considered. It results in symptoms limited to the contact area, usually at the skin [92] but also exogenous ocular ochronosis may occur [49,93-95]. Anamnesis and ocular aspects are extremely different from hereditary ochronosis: The cornea is more frequently involved and also the central cornea is affected.…”

Section: Discussionmentioning

confidence: 99%

On the ocular findings in ochronosis: a systematic review of literature

Lindner

Bertelmann

2014

BMC Ophthalmol

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BackgroundOchronosis/Alkaptonuria is a tyrosine metabolism disorder where accumulation of homogentisic acid, in eye, skin, cartilage and several other connective tissues leads to a black pigmentation of the affected tissues. It is autosomal-recessive inherited in men with a frequency of 1-9/1,000,000. While it is clear that pigment deposits lead to joint destruction, renal stone formation and cardiac valvulopathy respectively, the significance of ocular findings is still unclear. We therefore aim to evaluate the frequency and clinical significance of ocular findings in ochronosis and discuss possible therapeutic options.MethodsSystematic review of literature via Medline and Web of Science. Only case reports in English, German, French, Spanish or Italian documenting detailed ophthalmologic examination were included.ResultsOur search revealed 36 case reports including 40 patients. Average age at the onset of ocular signs was 40.6 years. The most frequent sign was symmetric brown sclera pigmentation present in 82.5 percent of the patients. “Oil-drops”, brown pigment spots in the limbus are generally considered pathognomonic but were a little less frequent (75 percent). Vermiform pigment deposits at the level of the conjunctiva or increased conjunctival vessel diameter is also frequent. We found an increased incidence of central vein occlusion and elevated intraocular pressure going along with chamber angle hyperpigmentation. Another condition observed twice is rapid progressive astigmatism attributable to corneoscleral pigment accumulation.ConclusionOur observations suggest that ocular findings are of double relevance. First, characteristic ocular findings can anticipate the time of diagnosis and second, ocular findings may complicate to various conditions putting sight at risk. Opthalmologists and general physicians should be aware of both. Therapeutic options include protein restriction, administration of high dose vitamin C or nitisonone. Evidence for all of them is limited.

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Section: Discussionmentioning

confidence: 99%

On the ocular findings in ochronosis: a systematic review of literature

Lindner

Bertelmann

2014

BMC Ophthalmol

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“…In many institutions worldwide, depigmentation therapy consists of the application of a bleaching agent containing MBEH 26,36–38 . Application of MBEH is reserved for induction of complete depigmentation in severely affected vitiligo patients who cannot or do not choose to repigment, as well as those who wish to be universally amelanotic 39,40 …”

Section: Monobenzyl Ether Of Hydroquinonementioning

confidence: 99%

Depigmentation therapies for normal skin in vitiligo universalis

AlGhamdi

Kumar

2010

Acad Dermatol Venereol

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If vitiligo involves most of the body, it might be easier to depigment the normal remaining skin rather than to attempt repigmentation. We reviewed the literature to date regarding available therapies for depigmenting the normal skin in vitiligo universalis. Our review revealed that the threshold regarding what percentage of body surface area qualifies as depigmentation is variable among practitioners. Monobenzyl ether of hydroquinone (MBEH) is the most widely used depigmenting agent and has few side-effects. Tretinoin in combination with MBEH is able to speed depigmentation of the skin. Monomethylether of hydroquinone has also been used successfully for depigmentation. Eighty-eight per cent phenol is also effective in depigmenting the skin but its application on large areas is toxic for liver and kidney. Different types of lasers are also available to destruct the melanocytes selectively, but this technique can be painful and expensive. Cryotherapy is a cheap depigmenting therapy but, because of scarring risk, it should only be used by experienced dermatologists. No trials have compared the efficacy of the above-mentioned well-established depigmentation agents/techniques. Certain drugs such as imatinib, imiquimod and diphencyprone, which are used to treat other diseases, caused depigmentation as a side-effect. Some depigmentation agents used for branding cattle can also serve as topical depigmentation agents. In conclusion, comparative clinical trials are needed to compare the efficacy of various depigmentation agents/techniques. In particular, topical imatinib, imiquimod and diphencyprone may be considered as potential depigmenting agents, which require further investigation. This review revealed that MBEH is safe and effective depigmenting agent.

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“…Monobenzyl ether of hydroquinone is used routinely by dermatologists for depigmentation of normally pigmented patches in patients with universal vitiligo. This compound must be used for at least 10 months (preferably more) 1 with many side‐effects 1,3,4 and there is a possibility of only partial depigmentation and a relatively high failure rate. 1 Repigmentation may also occur after complete depigmentation by monobenzyl ether of hydroquinone.…”

Section: Discussionmentioning

confidence: 99%