DPCP (Diphenylcyclopropenone) Immunotherapy in Severe Alopecia Areata: Clinical study of 36 cases

Mun, Ji Hun; Ihm, Chull Wan

Abstract

BACKGROUND
The treatment of alopecia areata is still only symptomatic and, depends on the clinical severity of the disease. The wider and longer the lesion, the more difficult the treatment is. Diphenylcyclopropenone (DPCP) topical immunotherapy has been tried in such severe cases but the methodology is not fully standardized and not legalized in this country. OBJECTIVE: Because of its different cutaneous reactions by different individuals, we want to know a safer methodology for the treatment of alopecia areata using DPCP, and rates of the hair regrowing and the cutaneous side effects of the agent in Korean people. METHODS: A total of 58 cases of extensive alopecia areata who had failed in previous treatments were subjected in this study. After sensitization of the patients with 2% DPCP in acetone, the subsequent on-going treatments were done with 0.001% to 2% with the interval of 3 to 14 days by the patients themselves in their home, after appropriate instruction. We evaluated the therapeutic efficacy of DPCP immunotherapy in 36 patients who were treated at least for more than 20 weeks and up to 2 years. Side effects were observed in all 58 subjects including the ones who gave up the treatment after being sensitized. RESULTS: In the 36 patients who were treated for more than 20 weeks period, a total of 27 (75%) of the patients showed a regrowth of hairs, a complete recovery was seen in 12 patients (33.3%) and a partial recovery in 15 patients (41.7%). Side effects were observed in 70.7% of patients (41/58). These were contact dermatitis, symptomatic lymphadenopathy, generalized pruritus, dermographism, dyschromia in confetti, trichoptilosis, in order of frequency. CONCLUSIONS: The DPCP immunotherapy appeared to be valuable, especially in such extensive cases resistant to more popular local or systemic corticosteroid treatment, despite its high incidency of allergic cutaneous side effects. Careful sensitization procedure and patient's education for selftreatment were stressed.