A new book on Vitiligo by Dr Antonio Salafia

Leprosy Mailing List – December 28^th, 2010

Ref.:   A new book on Vitiligo by Dr Antonio Salafia
From: Salafia A., Mumbai, India

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Dear Salvatore,

If you remember, a year ago there was an argument going on about my use of Dapsone (DDS) in Vitiligo; somebody reported that “Dapsone has no place in Vitiligo”.

Well, my claims have been vindicated by the paper “Innovative use of Dapsone” published in  Dermatologic Clinic Vol.28, July 2010, by Prof. Wozel of Germany.  In his rather exhaustive paper, he says that DDS inhibits reactive oxygen species; further he says that DDS is one of the strongest scavenger known and decreases H₂O₂, in this it is as potent as Catalase.  You certainly know that one of theories on the pathogenesis of vitiligo is ‘imbalance of oxidant-antioxidants’ and that is why Prof. Shallreuter has proposed the use of Catalase or Pseudocatalase, while other research workers have suggested the use of various antioxidants.

After using empirically, for many years, DDS in vitiligo, I went through the literature to find a justification to my protocol.  Among the many things I found that DDS is an antioxidant – as mentioned above; moreover it lowers the levels of Glutathione and has anti polymorpho-nuclear (PMN) neutrophils activity and that is why it is used in many, almost 20, dermatological conditions.  Many colleagues used to laugh at me when I mentioned that I use DDS in vitiligo.

After 25 years I have written a book on Vitiligo (340 pgs. and 126 photos; more details in the attachment); it is about my experience in almost 19 thousand patients.  In September 2010 I was invited to talk about “my experience of 24 years and 18 thousand patients treated”, at first World Congress on Vitiligo held in Milan. (No contradiction: every week I see about 150-200 new cases of vitiligo).

I got the book Dermatologic Clinic, where there is the paper of Prof. Wozel, only a few days ago; i.e. after my book was printed, so I could not incorporate his views.  However let me add a few more points (all the statements have the supporting evidence in my book):

1. My argument: melanogenesis is an oxidative process (and this is a fact) therefore how can an antioxidant help in such a case? I agree that, if there is an imbalance, a certain amount of antioxidants could be useful, but higher dosages may stop the ‘oxidative process’ and as a matter of fact, Vitamin C - a powerful antioxidant- stops the melanogenesis right at the beginning.  Vitamin E is of no use in vitiligo.  While DDS, in spite of being a potent antioxidant, does not interfere with melanogenesis, actual it helps it by lowering the levels of Glutathione and Cysteine – which are known to be high in the skin of vitiligo patients.  While Vitamin B6 regulates homocysteine and hence cysteine, which are known to favor the formation of pheomelanogenesis at the expenses of eumelanogenesis (refer to the ‘Switch theory of Ito).

Though Methemoglobinimia is a known side effect of DDS, I have come across with it in only 3 young girls, who had a deficient G-6PD (and they did not know); I have used DDS in Parsees (Zorohastrian originally from Persia) all known to be G-6PD deficient; low dosages of DDS have not caused any clinical problem.  Hypersensitivity reaction to DDS is extremely rare, and it is always related to dosages.

DDS is quite safe in pregnancy: in our leprosy hospital (which is a referral centre) we administer  regularly DDS to pregnant patients: we never had any problem.

In view of all this, I would suggest to stop the use of Vitamin C and Vitamin E, in vitiligo, and turn to DDS and Vitamin B6, as it is explained in my book.  Hundreds of patients come to me after using various lotions and oral medications, some have even used Tacrolimus (very good for lesions on the face) – to no avail; but, after I start them on DDS and Vitamin B6 (and even continue Tacrolimus) the improvement is remarkable (I take serial photos of most of the patients).

Your sincerely,

Dr. A. Salafia
Senior Dermatologist and Head of Dept. of Reconstructive Surgery
Vimala Dermatological Centre
Mumbai, India