Dermatology Online Journal

Camouflaging vitiligo with dihydroxyacetone
Sylvia Hsu, MD
Dermatology Online Journal 14 (8): 23

Department of Dermatology, Baylor College of Medicine, Houston, Texas. shsu@bcm.edu

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Abstract

Dihydroxyacetone (DHA), the active ingredient in sunless tanning agents, can provide cosmetically acceptable camouflage for some vitiligo patients.

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A 52-year-old Hispanic woman with a long history of extensive vitiligo affecting her face, trunk, and extremities presented for a prescription of 20 percent monobenzylether of hydroquinone (Benoquin®). She had tried various topical corticosteroid creams and topical immunomodulators. She did not want ultraviolet therapy because her son, who also had vitiligo and who initially experienced repigmentation with ultraviolet light therapy, lost the pigment after stopping treatment. She wanted a cream that would permanently get rid of whatever pigment she had left, so that her skin could be all one color. On physical examination, there were no signs of vitiligo. The patient had a tan covering her entire skin surface, excluding her palms and soles. She admitted that she had received a spray type of treatment at a sun-tanning salon and was given a bottle of dihydroxyacetone for "touch-ups." Since she was able to camouflage her vitiligo so well, the author advised her to continue her current regimen and not to consider applying Benoquin®.

Vitiligo is a common depigmenting disease of the skin of unknown etiology. Patients often feel self-conscious and the condition can affect them socially and emotionally. There is no known cure and response to various treatment modalities is inconsistent. Dihydroxyacetone (DHA), a 3-carbon sugar, is the active ingredient in sunless tanners. It temporarily stains the skin a golden brown color by reacting with proteins in the stratum corneum to form brown chromophores, called melanoidins [1, 2, 3]. The staining can last up to 10 days. Lower concentrations of DHA impart lighter tans, whereas higher concentrations impart darker tans [3]. Thus, vitiligo patients can choose the concentration that most closely matches the color that they want to achieve. Although DHA is not considered to be a sunscreen, one study did show that the skin-staining achieved by application of DHA may delay the development of skin cancer in hairless mice that were irradiated with moderate doses of ultraviolet light [4]. However, the protection is minimal and DHA formulations typically have a sun protection factor of only 3 or 4, that last for only several hours after application [3]. Therefore, sunscreens are still required. DHA is an easy and convenient option for patients who want to camouflage their vitiligo.

References

1. Muizzuddin N, Marenus KD, Maes DH. Tonality of suntan vs sunless tanning with dihydroxyacetone. Skin Res Technol. 2000 Nov; 6(4): 199-204. PubMed

2. Nguyen BC, Kochevar IE.Influence of hydration on dihydroxyacetone-induced pigmentation of stratum corneum. J Invest Dermatol. 2003 Apr; 120(4): 655-61. PubMed

3. Draelos ZD. Self-tanning lotions: are they a healthy way to achieve a tan? Am J Clin Dermatol. 2002; 3(5): 317-8. PubMed

4. Petersen AB, Na R, Wulf HC.Sunless skin tanning with dihydroxyacetone delays broad-spectrum ultraviolet photocarcinogenesis in hairless mice. Mutat Res. 2003 Dec 9; 542(1-2): 129-38. PubMed

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