Topical immunotherapy of severe alopecia areata with diphenylcyclopropenone (DPCP): experience in an Iranian population

Shahin Aghaei

doi:10.1186/1471-5945-5-6

Abstract

BackgroundHighly variable results of topical diphenylcyclopropenone (DPCP) in the treatment of alopecia areata have been reported so far. The purposes of the present study were to evaluate the efficacy and tolerability of DPCP treatment in severe alopecia areata.MethodsTwenty-eight patients (16 female and 12 male, 10–35 years old, mean age 25 years) with extensive alopecia areata were enrolled in an open-label clinical trial. After sensitization with 2% DPCP, progressively higher concentrations beginning at 0.001% were applied weekly for 6 months to one side of the scalp, after which, if terminal hair growth was noted, the entire scalp was then treated under the same weekly protocol. The maximum concentration of DPCP in acetone was 2%.ResultsTwenty-seven of 28 patients completed therapy. The overall response rate was 81.5% (22/27), complete remission (90%-100% terminal hair re-growth) was obtained 22.2% (6/27) and partial remission (10%-90% terminal hair re-growth) in 59.3% (16/27). In all patients an eczematous reaction consisting of erythema, itching, and scaling at the site of application were observed. During therapy, other side effects including, occipital lymphadenopathy 40.7% (11/27), severe eczema/blister formation 40.7% (11/27), hyperpigmentation 18.5% (5/27) were observed, but no hypopigmentation, vitiligo, contact urticaria, and erythema multiforme-like reaction were seen in the patients. Nineteen of 27 (70.4%) patients had at least one side effect, other than eczematous reaction. Notably, partial recurrence was observed in 50.9% (13/22) of these patients after 6 to 12 months of follow-up. During the follow-up time the maintenance DPCP immunotherapy was continued.ConclusionTopical DPCP treatment for alopecia areata is an effective therapy with a slightly high relapse rate during bilateral maintenance treatment. According to the author's knowledge this is the first experience with DPCP in Iran.

Highlights

Variable results of topical diphenylcyclopropenone (DPCP) in the treatment of alopecia areata have been reported so far
Individuals with AA were ineligible for DPCP treatment if they presented with less than 40% scalp involvement, the age less than 10 years, significant cardiovascular disease, pregnancy, or serious intercurrent medical illnesses
The way in which DPCP operates on hair follicles in AA still remains to be elucidated

Summary

Introduction

Variable results of topical diphenylcyclopropenone (DPCP) in the treatment of alopecia areata have been reported so far. The purposes of the present study were to evaluate the efficacy and tolerability of DPCP treatment in severe alopecia areata. Dermatosis of the scalp such as alopecia areata (AA) are a burden for many patients and often resistant, even to extensive therapy [1,2,3,4]. Some success, has been reported with anthralin, but results seem variable [6,7]. Other therapies which have been tried, with variable success, include minoxidil [8,9], cyclosporine [10,11,12], alpha-interferon [13], and acupuncture [14]

Methods

Results

Conclusion