I have vitiligo over more than 70% of my body. As I have relatively little skin left with my natural colour, could I depigment the rest to achieve an even tone?

Hello Patricia,

I fully understand the logic of your question after living with such extensive vitiligo for years. However, I want to be very clear with you: deliberately depigmenting the healthy skin that still keeps its colour is not a trivial cosmetic decision and should never be done on your own.

Therapeutic depigmentation does indeed exist for certain patients with very extensive vitiligo. So I cannot tell you it is a procedure that is never performed. But it is reserved for highly selected situations, usually when the vitiligo is extensive, stable, affects a large part of the body surface and the reasonable chances of repigmentation are very limited.

What does it involve? Gradually removing the melanin from the areas that still hold pigment, in order to try to achieve a more uniform appearance. The problem is that we are talking about deliberately destroying normal, functional pigmentation.

And this has consequences.

Melanin is not there only to determine the colour of our skin. It is part of our natural system of protection against ultraviolet radiation. A person with very extensive depigmentation will have to be especially rigorous with sun protection for the rest of their life.

In addition, therapeutic depigmentation may be permanent or hard to reverse. Nor is the result necessarily perfectly uniform: resistant areas, irregular repigmentation, irritation, dermatitis and differences in tone can appear. For this reason, it should not be approached as if it were simply «removing the colour that is left».

I also consider it essential to weigh the psychological impact of a decision of this magnitude. Not because wanting uniform skin implies having a mental health problem, but because we are talking about potentially irreversibly modifying an important bodily characteristic. Before doing so, we must be sure that the person fully understands what they are gaining, what they are losing and how they may feel afterwards.

That is why, faced with a patient whose vitiligo affects roughly 70% of the body surface, I would not directly recommend depigmentation simply because there is less pigmented skin left.

First I would carry out a complete medical assessment of the skin: the extent and stability of the vitiligo, the location of the residual areas, previously performed treatments, the real chances of repigmentation and the impact of the disease on quality of life.

We now also have different therapeutic strategies for vitiligo, and the approach must be individualised before assuming that the only possible solution is to remove the remaining pigment.

And I especially want to insist on one thing: I do not recommend buying depigmenting creams over the Internet, compounded formulas of dubious origin, or using substances intended to bleach the skin without medical supervision. Trying to achieve extensive body depigmentation on your own can cause chemical burns, severe dermatitis, permanent pigmentation changes and other complications.

Medicine also means knowing when we should stop before carrying out a treatment.

In extremely extensive vitiligo, therapeutic depigmentation can indeed be considered, but it must be the result of a carefully weighed medical decision shared with the patient, not an improvised cosmetic solution.

My recommendation in your case would be to first have a specific medical consultation about vitiligo, study all the available alternatives and only then decide which is the most appropriate and safest path for you.

Warm regards,