Monobenzone May Heighten Oxidative Stress and Systemic Health Concerns, Study Suggests

Treatment with monobenzone cream in patients with vitiligo led to a significant increase in depigmented skin patches, with vitiligo coverage rising from 62% to 91%, according to a recent study.

The study, published in the Journal of Cosmetic Dermatology,¹ also reported heightened inflammatory cytokines and oxidative stress markers.

Ankle vitiligo | Image Credit: © DermNet

Background and Methods

The study aimed to evaluate the clinical and biochemical effects of monobenzone, or MEBHQ (monobenzyl ether of hydroquinone) cream,² in patients with vitiligo, comparing these findings with a healthy control group. The research delved into various factors including vitiligo patch area, inflammatory cytokine levels, oxidative stress markers, and other health parameters like body mass index (BMI), blood sugar, and organ function.

The study involved 2 main groups: patients with vitiligo and healthy controls. The vitiligo group was further subdivided into 2 phases—before and after treatment with MEBHQ cream. The aim was to assess changes in vitiligo patch area, inflammation, oxidative stress, and overall health after using the cream. Age and other demographic factors were controlled, ensuring no significant differences between the groups at baseline.

Findings

As a result of the study, researchers observed an increase in the depigmented area following MEBHQ treatment. The average percentage of vitiligo coverage increased from 62% before treatment to 91% after treatment, indicating the cream's efficacy in expanding depigmented patches and creating a more uniform skin tone. This outcome was statistically significant, demonstrating a marked difference between pre- and post-treatment stages. In contrast, the healthy control group showed no vitiligo patches.

The results demonstrated that MEBHQ treatment had no significant effect on BMI or key biochemical parameters like blood sugar and kidney and liver function. Before and after treatment, the BMI values of vitiligo patients were nearly identical, and both were comparable to those of the control group.

Likewise, fasting blood sugar, kidney markers (blood urea nitrogen and creatinine), and liver enzymes remained within normal ranges throughout the study.

The study also took a closer look at inflammatory processes in vitiligo by measuring the levels of cytokines IL-1β and IL-18 in the blood. These markers were significantly elevated in patients with vitiligo compared to the healthy controls, both before and after treatment with MEBHQ.

However, MEBHQ therapy further increased IL-1β and IL-18 levels, implying that while the cream is effective in depigmentation, it may contribute to an inflammatory response in vitiligo patients. The rise in cytokine levels after treatment was also statistically significant.

Both Total Oxidative Stress (TOS) and malondialdehyde (MDA) were significantly higher in patients with vitiligo compared to the control group, indicating elevated oxidative stress. Following MEBHQ treatment, TOS levels increased even further, with the rise reaching statistical significance. On the other hand, MDA levels also increased post-treatment, but this change was not statistically significant.

Researchers also identified positive correlations between the percentage of vitiligo patches and the levels of IL-1β, IL-18, TOS, and MDA, with particularly strong associations noted for IL-1β and TOS. Regression analysis further confirmed that TOS was the most predictive biomarker for vitiligo severity, followed by IL-1β. MDA, while elevated, was not a significant predictor of disease status.

Conclusions

"Although the 60%–90% increase in vitiligo patches shown in this study could promise short-term use and the negligible side effects in these people, chronic exposure of body to MBEHQ-induced oxidative stress may contribute to the development systemic disorders including liver, kidney, pancreas, and heart failures," according to study authors Khalid et al.

Researchers suggested further studies measuring for effective dosing and blood absorption, noting that these factors may play a role in minimizing adverse effects and minimizing oxidative stress.

References

1. Khalid-Meften A, Liaghat M, Yazdanpour M, et al. The effect of monobenzone cream on oxidative stress and its relationship with serum levels of IL-1β and IL-18 in vitiligo patients. J Cosmet Dermatol. September 23, 2024. https://doi.org/10.1111/jocd.16544
2. Rordam OM, Lenouvel EW, Maalo M. Successful treatment of extensive vitiligo with monobenzone. J Clin Aesthet Dermatol. 2012;5(12):36-39.