Leprosy Mailing List – December 19th, 2007
Ref.:
Melanocytes in vitiligo skin?
From: Salafia
A., Mumbai, India
Dear Salvatore,
This has reference to the note of Prof.
Nordlund (LML December 13th, 2007). We had a brief discussion many
years ago and I appreciated, as I do appreciate now, his attitude.
The whole story (this debate on the LML)
started with the side effects of Dapsone, and now it has been
side-tracked to vitiligo. I
do not intend to go on writing about vitiligo, but let me make my
final comments:
1. The old school believes that in
vitiligo skin there are no melanocytes, but the most recent research
works, like Shallreuter, say that melanocytes are present but non
functioning. I have been
saying this for the last 20 years, because I have seen patients - a
number of them - who had vitiligo for 20 years or more and yet they
repigmented. If
melanocytes were dead, from where did the pigment come? One cannot assume that pigment
came from nearby cells, because such a phenomenon can happen for small
patches, but when a patient has both forearms white -like the
cases I report, there is no close by area where melanocytes can
migrate from.
2. Dapsone; I am sorry I have not been able to make the readers
understand my position: it is not that we planned to use Dapsone in
Vitiligo because we knew, in advance, all of its activities and side
effects; no. The story is
that a nurse, working in a hospital in Eluru, Andhra Pradesh, was
transferred to our hospital and she told me that in Eluru the doctors
were using Dapsone to treat Vitiligo.
So, ready as I am to try always new ways,
I started using Dapsone in the early 1908's. I soon realized the value of
it, and I made it the major component of our regimen for Vitiligo. Later on, I tried to find,
from the literature, how Dapsone can be useful in Vitiligo. Whatever references I gave in
my previous letter are only few, and I do not rule out that Dapsone
may work in ways that we do not know. But
saying that Dapsone in Vitiligo is useless.... is too hasty.
Moreover somebody should tell those 15
thousand patients (these are in my computer now and another 5 thousand
data I lost for various reasons) that they are wrong in using Dapsone;
I believe it would be very difficult to convince them.
One last word: yesterday an Indian patient
-settled in the USA for the last 15 years- came to me with some skin
problem. He asked me:
"Do you remember me? - No - Well I had Vitiligo 20 years ago, you
treated me and I was cured, and I have had no relapse in all these
years".
Best wishes to all.
Antonio Salafia
