Dr. Antonio Salafia shares his 25 years of experience treating vitiligo, outlining various protocols using dapsone and vitamin B6, among other treatments. He reports on the effectiveness of these treatments across over 19,000 patients and discusses outcomes based on different body areas. Salafia highlights that while many patients showed significant improvements, challenges remain in treating difficult cases and certain areas of the body.

1. Vitiligo: my experience of 25 years and
19.156 patients
Dr. Antonio Salafia
Dermatologist & Head Dept. Reconstructive Surgery.
Vimala Dermatological Centre, Mumbai
St.Petersburg, Russia.
July 7th 2011

2. The experience of a clinician.
• In the early 1980’s I was disappointed with
PUVA, so I explored other avenues:
a) From the year 1980 Dapsone was used at Vimala
Dermatological Centre, with some success.
b) In 1983 I set a protocol:Dapsone, Vitamin
B6 -suggested by C. Frati from IDI,Rome.
• In 1985 I began experimenting with new lotions,
inspired by the work of Prota. (Protocol C).
Antonio Salafia

3. Protocol ‘C’
ORAL THERAPY:
• Dapsone: 0.5 mgs K/wt.
• Vitamin B6 100-300 mg. a day, Iron, Folic Acid.
LOCAL APPLICATION:
• Face: Locoid (Hydrocortisone Butyrate) Tacrolimus.
• Neck: Lotion A (the mildest).
• Body / Arms and Legs: Lotion B (strong).
• Arms, Legs, Hands, Feet : Lotion 5 –F (strongest).
Antonio Salafia

4. Dapsone: possible mode of action.
a) Antioxidant: a. Potent scavenger of free radicals (T. Ryan)
b. Decreases H2O2 - as good as Catalase (Wozel).
c. Weak inhibitor of prostaglandin synthesis.
d. Scavenger of oxidative intermediates, and
suppressor of PMN (which produce ROS).
B) Decreases the level of Glutathione: skin of vitiligo patients has a
higher content of Glutathione. By suppressing Glutathione we
favor the formation of Eumelanins instead of Pheomelanins (Ito).
C) Possible beneficial effects.
DDS is an immunomodulator + suppressor of PMN cells, hence
effective in diseases wherein there is dense infiltrate of PMN:
Dermatitis Herpetiformis, Subcorneal Pustular Dematosis, Scarring/
Bullous Pemphigoid and more than 20 other diseases.
Antonio Salafia

5. Vitamin B6: importance.
• Vitamin B6 is a potent antioxidant.
• Involved in the homeostasis of Glutathione and
Cysteine (switching mechanism of Ito).
• In high doses, is capable of transforming
Glutammic acid into Pyrrolecarboxylic acid and
prevents the formation of Glutathione (Frati).
• In my experience, it helps to prevent new
patches, so I advise my pts. to keep on taking
for years.
• (It prevents homocysteine-induced atherosceloris in rats).
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6. First experiments with my protocol
and my lotions.
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7. Face: Locoid
Arms: Lotion B
Cure in 6 months.
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8. Lotion 5-F
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9. Dapsone+B6
and Locoid
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10. Locoid… Lotion A
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11. Protocol C + Lotion 5-F.
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12. Face: Locoid. Neck: Lotion A
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13. Lotion B
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14. Lotion 5-F. Stopped oral
medications and relapsed.
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15. Chemical Vitiligo: Lotion A
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16. Lt. Lotion B. Rt.Lotion 5-F
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17. Lotion 5-F
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18. Results in 8730 (out of 13.119)
• Protocol ‘A’: Vitamins, Iron, Copper; creams: Betnovate/Placenta extract.
• Protocol ‘B’ : Orally as above + Dapsone+ locally Locoid/ Betnovate.
• Protocol ‘C’: Dapsone 0.5 -1.0 mg/k/w + all the Vitamins,
Local application
Children : Locoid for face, Lotion A for body.
Adults: Face & Neck: Locoid / Lotion A /Tacrolimus.
Body: Lotion B.
Limbs: Lotion 5-F.
• Protocol ‘D’ : all of these except Dapsone; in its place, oral steroids.
• Given the large number of patients treated, protocol A can be considered as
‘control group’ vs. protocol ‘B’ and ‘C’’.
• I cannot due ‘double-blind trials’ in patients who are
desperate for a cure.
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19. How to read the charts.
• Worse/Nil = are self-explanatory.
• Poor = improvement less than 25%.
• Fair = improvement 25% to 50%.
• Good = > 50% but < 75%.
• Excellent = more than 75%.
• Almost cure = extensive lesions, ‘cured’ except
for one or two stubborn patches.
• Cure = total and permanent cure.
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20. Protocol A: Vitamins…
Protocol A – 1673 pts.
700
600
500
400
300
200
100
0
CURE AC E G F P N W
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21. Protocol B: Vitamins+DDS
Protocol B - 1587 pts.
500
400
300
200
100
0
C AC EX G F P N W
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22. Protocol C: DDS+Vitam+My Lotions
Protocol C - 4661 pts.
1200
1000
800
600
400
200
0
C AC EX G F P N W
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23. Protocol D:
Steroids + Vitamins + Lotions
Results with Protocol D – 809 pts.
200
150
100
50
0
C AC EX G F P N W
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24. Protocol A – 1673
700
Protocol C –
600 1200 4661
500 1000
400 800
300 600
200 400
100 200
0
CURE AC E G F P N W 0
C AC EX G F P N W
Protocol B - 1587
Protocol D – 809
500
200 pts.
400
150
300
200 100
100 50
0 0
C AC EX G F P N W C AC EX G F P N W
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25. Results could be better, and lately they are.
Some patients could not follow the therapy because:
- Sunlight not possible: working hours, ladies with lesions
on chest, thighs; artificial lamps are costly.
- Some patients live far away, even outside India…
- Others changed residence, job, got married…
- Some poor patients could not afford the treatment.
- Others expected miracles.
- Certain areas of the body are ‘difficult’ : fingers, toes,
bony prominences…..
- Few of them came to rule out ‘Leprosy”.
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26. Private Patients from Jan. 2005 to
Dec. 2008. 2940 pts.
• Protocol C + Inj. Triamcinolone 40 or 20
mgs. I.M. once a month x 3 - 5.
• Fast results (due to Kenacort) and
• Consistent results (due to Dapsone and B6).
• Patients treated 2940: report on
‘regulars’ only: i.e. 2012 cases.
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27. Private Patients: Results.
600
500
400
300 1 – 19
200 20 - >
100
0
Cure A-cure Exc Good Fair Nil Worse
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28. Cure Acure Excellent Good Fair Nil Worse Total
_________________________________________________________
• Face 427 301 375 175 56 37 0 1371
-----------------------------------------------------------------------------------
• Limbs 523 319 362 187 110 94 17 1822
-----------------------------------------------------------------------------------
• Hand/
Feet 71 52 95 104 159 287 31 819
------------------------------------------------------------------------------------
• Body 467 262 326 24 43 37 16 1175
-----------------------------------------------------------------------------------
• Vagina 58 21 33 17 14 21 0 164
------------------------------------------------------------------------------------
• Penis 15 11 16 30 42 31 5 150
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29. Results, as per area of the body.
800
Face
700
600 Limbs
(each)
500
Hands/ Feet
400 (each)
300 Body
200 Vagina
100 (mucosa)
Penis
0
(glans)
Cure Excellent Fair Worse
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30. 500
400
Results as per
300 body area:
200 Face Face: 1371
100 Body: 1175
0
Cure Good Worse
Limbs: 1822
500
600
500 400
400 300
300 Limbs Body
200
200
100
100
0 0
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31. Results:
300
250
200
Hand/
Feet
Hands/ Feet: 819
150
Vagina: 164
Glans Penis: 150
100
50
0
60 50
50 40
40 Vagi 30
na
30 Penis
20
20
10
10
0 0
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32. Applied Aloe Vera, got Vitiligo.
Protocol C + Tacrolimus 0.1%.
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33. Difficult cases
Lotion A x 1 year.
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34. First Locoid, then Lotion A.
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35. Segmental: lotion A; 6 mth- 1year.
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36. Arms: lotion 5-F. Face not responding to anything.
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37. Good response in majority of patients:
Face: lotion A. Legs: lotion 5-F.
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38. Protocol C + Lotion A.: 3 months.
(very irregular patients) 19 months.
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39. Lotion A: 6 months.
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40. Neck: Lotion A. Arms: Lotion B.
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41. Father & Mother affected too.
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42. Protocol C +
Tacroz 0.1%:
20.08.2009
11.12.2009
4.04.2011
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43. Lotion A:
- 22.08.2008 -
19.09.2008
- 5 months.
Duration of Disease
8 years.
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44. Lotion 5-F: 4 months.
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45. Lotion 5-F: 4 months.(very irregular).
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46. Face: Tacroz … Lotion A
Hands: Lotion 5-F.
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47. Neck: A. Arms: 5-F, 4-6 months.
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48. Face:Tacroz.
Arms and Legs:
Lotio 5-F.
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49. Locoid: 6 months.
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50. Lotion A.
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51. Neck: Lotion A. Arms: Lotion 5-F.
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52. Locoid: 5-6 months.
17 years later.
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53. Neck: Lotion A.
Legs: Lotion 5-F.
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54. Tacroz 0.1. Arms: lotion 5-F.
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55. Lotion A,
Lotion 5-F.
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56. Girl: Tacrolimus. CHILD: Vitix: worse, 9.8.2008.
Locoid: 27.9.208 cure in 2 months.
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57. Lotion A : 2 months.(treatment is going on)
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58. Face: Locoid. Neck: Lotion A. After 2 months.
(Photoes: 20.9.08 18.10.08 15.11.08)
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59. Treated elsewhere with only locoid. My
protocol + Locoid for face. Legs: A
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60. Face Lotion A, Abdomen Lotion B
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61. Patient lives in England: 4 months.
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62. Lotion B:
2 months.
5 months.
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63. Face:Locoid
Arms: Lotio
5-F:
6 months.
Disease Ext.
Duration 8 yrs
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64. Face:Locoid,
Neck:Lotion A
Arms:Lot. B:
6 months
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65. Tacroz 0.03%, later on Homeopathy x 2 years…Worse.
Protocol C + Tacroz 0.1%. Photo 12.3.11 16.4.11
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66. Latest photos: 18 June of 2011.
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67. ANA and anti-DNA –ve. Anti-Thyroglobulin +ve.
Photos: 10.9.2010, 13.12.2010, 2.7.2011.
Dapsone, Tacroz 0.1%, latest: Lotion A.
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68. Surgery. Good and bad surgery.
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69. Surgery done elsewhere by a well-known
dermatosurgeon.
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70. Punch graft by same dermato(surgeon).
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71. Operated twice with
punch graft.
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72. Conclusion:
Most patients can be cured; but, there are
difficult cases and difficult areas.
We are still working on it, because our aim is set high..
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73. Antonio Salafia

74. Thanks to you all
and
a big thanks to the organizers.
Antonio Salafia