Comparative Study on the Efficacy of Diphenylcyclopropenone Alone and in Combination with Intralesional or Systemic Corticosteroids for the Treatment of Extensive or Refractory Alopecia Areata

Abstract

Alopecia areata is a non-scarring autoimmune disease affecting hair follicles. It is seen commonly as patchy lesion of hair loss, and sometimes as extensive involvement of the whole scalp (AT) o whole body (AU). Still, there is a controversy about prediction of AA clinical course and variability of the response to treatment. However, Spontaneous remission can occur in approximately 80% of limited AA within one year. Many treatment modalities have been used for AA. In a localized AA, intralesional corticosteroids are the first-line treatment. Topical immunotherapy is widely used in treatment of AA aiming to alter the immune response inducing hair regrowth through inducing a low-grade chronic dermatitis. Diphenylcyclopropenone (DPCP) is among immunotherapeutic agents used for treating a chronic severe AA, with greater than 50% scalp involvement and refractory AA with response rate of 5% to 85%. Relapse can occur in 60% of patients after completion of treatment. We aimed to evaluate the efficacy and safety of topical DPCP alone and in combination with intralesional steroids or systemic steroids for treatment of extensive and refractory AA. The study enrolled 21 adult patients with severe