Abstract
Introduction: Topical immunotherapy with diphenylcyclopropenone is a treatment option for patients with refractory or extensive alopecia areata. The aim of this study was to evaluate the clinical efficacy and tolerability of diphenylcyclopropenone therapy, in patients with alopecia areata, and identify possible prognostic factors that predict response to treatment.
 Methods: We conducted a retrospective study that included all patients diagnosed with alopecia areata and treated with diphenylcyclopropenone at our Department.
 Results: Twenty one patients were included for analysis (15 females and 6 males). Overall, nine patients (42.9%) had some hair regrowth with diphenylcyclopropenone therapy. Of these, five (55.6%) achieved pigmented terminal hair regrowth but with persistent patches of alopecia. Only one patient achieved > 90% of hair regrowth. Older age at onset, broader extent of alopecia at baseline and presence of nail dystrophy were all negative prognostic factors (p < 0.05). Atopy and thyroid dysfunction were not statistically significant as predictors of poor treatment outcome. Adverse effects were documented in 15 patients, most of them were mild and did not lead to treatment interruption.
 Conclusion: Diphenylcyclopropenone therapy is a viable treatment option in patients with extensive alopecia areata, although the response is partial in the majority of the cases. Limitations of this study include its retrospective nature and the limited number of patients.
Highlights
Alopecia areata (AA) is a chronic inflammatory condition primarily affecting the hair follicle, resulting in non-scaring patchy hair, ranging from limited patchy hair loss to complete loss of both scalp and body hair.[1]
1 patient achieved > 90% of hair regrowth. These six patients with the best treatment response were younger than 40 years old
We found that the age of onset was a factor statistically significant (p < 0.05) of a better treatment response to DPCP
Summary
Alopecia areata (AA) is a chronic inflammatory condition primarily affecting the hair follicle, resulting in non-scaring patchy hair, ranging from limited patchy hair loss to complete loss of both scalp and body hair.[1] The exact pathophysiology of AA remains poorly understood but current evidence suggests that is an immune-mediated disease in which CD8+ T-cells target the hair follicle.[2] AA can resolve spontaneously, it is known to be a cosmetic burden with a high impact on quality of life, effective treatment options are required. The first steps in treatment most often consist of topical or intralesional corticosteroids. Immunotherapy is one possible treatment modality and, to date, diphenylcyclopropenone (DPCP) is considered as the topical sensitizer of choice because of its stability and safety profile.[3] The mechanism of action is unclear, but an immune-deviation strategy, inducing an allergic contact dermatitis, might be involved. Its reported efficacy is variable, and the individual response cannot be predicted.[4]
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