Leprosy Mailing List – December 11th, 2007
Ref.: Dapsone,
a major component of an anti-vitiligo treatment regimen
From: Salafia
A., Mumbai, India
Dear Salvatore,
This has reference to the statement of Dr. Narisamha Rao (LML
December 7th, 2007).
More than a statement, this sounds like a Supreme Court
judgment: "Dapsone is useless in Vitiligo. Sentence passed. No
appeal". I do
not agree.
Dapsone in Vitiligo was used, for the
first time, in a Leprosy Hospital in Eluru, Andhra Pradesh, India and,
the first paper on the subject came from Andhra Pradesh too.
This is a Leprosy Forum, and not Vitiligo,
so I cannot exceed my briefing, but a few references are a must,
lest the readers may think that my statements are baseless. The facts:
1.
It is an accepted fact that the skin of Vitiligo patients has a higher
level of Sulphydryl groups (Cysteine and Glutathione), and we know
that the Sulphydryl groups are responsible for diverting the process
of melanin formation towards the Pheomelanins (which are the
white pigments) at the expenses of the Eumelanins. References:
1.a.
Van Scott E.J. Flesch P.: Sulphydryl
groups and disulfide linkages in normal and pathological
keratinization. Arch. Dermat Syph. 70:141 (1954)
1.b.
Rao D.S., Susheela A.K., Pandhi P.K. et alias: Tissue sulphydryl groups and
ascorbic acid in Vitiligo. Ind.
Journ Dermat Ven Lepr. 45; 274-276. (1979)
2.
It is a fact that Dapsone reduces the levels of Glutathione
and Cysteine in blood. References:
2.a.
Desforges J.F., Thayer W.W.,Dawson
J.P.: Hemolityc anemia
induced by sulfoxone therapy, with investigations into the mechanism
of its production. Am
J. Med. 27 :132-136. (1959)
2.b.
Rasbridge M.R., Scott G.L.: The
Hemolytic action of Dapsone; the effect on red cell glucolysis. Br. J.
Haem 24; 169-181.(1973)
An Italian Journals, Chronica
Dermatologica (the most authoritative Italian Journal on Dermatology)
has published -IN ENGLISH LANGUAGE- the following article:-
Salafia A. Successful
treatment of Vitiligo with Dapsone.
Review of 5601 cases. Chronica
Dermatologica. Vol. V pg.
171-187. (1995). Today,
in Mumbai, the cases we have treated are more than 15 thousand.
The whole story of Vitiligo and its
treatment is a complex one and I cannot do justice to it in a
short note; at any rate, Dapsone is the major component of our
treatment, which includes Copper Sulphate, Folic acid, Iron
Sulphate and Vitamin B6 in high dosage. The junior
dermatologists who work with me at Vimala Dermatological Centre,
initially are sceptic about the use of Dapsone, but, once they see the
results (and hear the patients comments) they too adopt it.
I can give sufficient references to show the value of Dapsone
in vitiligo; moreover at Vimala Dermatological Centre we have tried
therapies with and without Dapsone, and have noted a marked
difference in the outcome of the disease when Dapsone is added to
Copper, Folic acid, Iron, and Vitamin B6. It has to be tried not only on
those cases which are notorious for been difficult to treat (like
malleoli and fingers). It
is a fact that we are using dapsone from 1985 (circa) till today and
we (the patients too!) find it useful in very low dosages like 50 mgs
3 times a week.
My last word: those who are interested in this regimen, can
kindly get in contact directly with me and I will send them my book on
Vitiligo (published in January 2004) with the full story.
I thank you for allowing me to clarify my views on Dapsone.
Antonio Salafia
