COMPARATIVE EVALUATION OF DI-PHENYL CYCLO- PROPENONE AND ANTHRALIN IN TOPICAL IMMUNE THERAPY IN ALOPECIA AREATA

Abstract

Alopecia areata (AA) is a common, non-scarring dermatologic condition. The clinical phenotype and disease course is variable, but the etiology for AA remains an enigma. However, clinical and experimental studies have pointed to autoimmune involvement, specifically regarding immune privilege sites of the hair follicles and the infiltration of CD4 + and CD8 + T cells and a predominant Th1 cytokine profile. Environmental insults, such as viral infections, trauma and genetic predisposition are also believed to contribute to the disease process. Therefore, therapies are mostly immunosuppressive whether topical or systemic. Nevertheless, treatment is still a challenge in AA, and no treatment is either curative or preventive. Contact immunotherapy is one of the best documented treatments in severe alopecia areata giving cosmetically acceptable hair regrowth. It has been used because of its irritant and immune modulatory properties. The aim of this work was to provide a comparative evaluation of the effect of topical Anthralin versus topical Diphenyl cyclo prepanone in the treatment of extensive alopecia areata.

Our study included 60 patients subdivided into three groups; 20 patients each (Anthralin, DPCP and control groups). Each patient was subjected to a detailed history taking, general and dermatological examination. The obtained data were tabulated and subjected to statistical analysis using different tests of significance. The study could show superiority of anthralin over DPCP as shown by the significant difference in score reduction between two groups at the end of the study. This study shows that the treatment with anthralin and DPCP have a confirmed efficacy in extensive AA. After 3 months of treatment, complete hair regrowth was observed in 8 patients (40%) who received anthralin, and 6 patients (30%) treated with DPCP. whereas partial hair regrowth showed through 12 patients (60%) among both groups (Anthralin and DPCP), none of the patients showed no response with anthralin treatment, while only 2 patients (10%) treated with DPCP had no response to hair regrowth. Evaluation of Control (placebo) group patients after placebo treatment, 10% of patients had partial hair regrowth and the remaining 90% had no response. Our present study could not show any correlation between therapeutic response and age of the patients or duration of the disease in either of the treatment groups. As there was insignificant difference in clinical response after anthralin versus DPCP treatment, both might be reliable in dealing with extensive resistant AA, however anthralin has some advantages. It has less cost than DPCP, topically applied, can be successfully and safely self-administered at home, which would further increase treatment compliance, and effective in extensive resistant cases without immuosuppression. As expected some local side effects with anthralin and DPCP, localized purities, vesicles, bullae, superficial folliculitis or a combination of these (in DPCP and anthralin), staining of skin, hair, and clothes (in anthralin). No relapse was noticed among patients in both groups after 3 months of treatment as the duration of follow up in the study was not long enough to assess relapse rate.