Original article
Subclinical sensitization with diphenylcyclopropenone is sufficient for the treatment of alopecia areata: Retrospective analysis of 159 cases

https://doi.org/10.1016/j.jaad.2017.10.042Get rights and content

Background

Contact immunotherapy with diphenylcyclopropenone (DPCP) is presently considered the treatment of choice for extensive alopecia areata. However, a major concern with contact immunotherapy is that it causes various adverse effects (AEs) that contribute to discontinuation of treatment.

Objective

We investigated whether a modified DPCP treatment protocol can promote hair regrowth with fewer AEs.

Methods

All patients were sensitized with 0.1% DPCP and began treatment with 0.01% DPCP. Thereafter, the DPCP concentration was slowly increased according to the treatment response and AEs. This was a retrospective review of DPCP treatment with modified protocols in 159 patients with alopecia areata.

Results

Of the 159 patients, 46 (28.9%) showed a complete response and 59 (37.1%) showed a partial response. No patients had AEs after sensitization. During the treatment, only 3 patients (1.9%) showed severe AEs, and 55 showed moderate AEs; however, all were well controlled with antihistamines alone or antihistamines and medium-potency topical steroids. There was no association between treatment response and AEs.

Limitations

Sample size, subject composition, and the retrospective study design represent potential limitations.

Conclusion

A modified DPCP treatment protocol with subclinical sensitization could induce a favorable therapeutic response and result in fewer AEs.

Section snippets

Patient selection and demographics

The cases of 159 patients with AA who were treated with the modified DPCP protocol in Wonju Severance Christian Hospital between January 2003 and December 2016 were retrospectively reviewed.

All types of AA, including patchy alopecia, alopecia totalis, and alopecia universalis, were included. Each medical record was reviewed for demographic and clinical information including age, sex, clinical subtype, age at disease onset, disease duration before DPCP treatment, antinuclear antibody titer,

Subject demographics

The demographic and clinical data are shown in Table I.

Absence of AEs in the sensitization process and overall fewer severe AEs during the treatment

None of the 159 patients complained of AEs after sensitization (Table II). During treatment, 61 reported no symptoms, including itching. Itching was mild in 40 patients, moderate in 38, and severe in 20. An antihistamine was prescribed for patients with moderate or severe itching. Of 20 patients with treatment site erythema, 11 showed scaling and were prescribed a topical steroid to manage discomfort. Two patients with blisters and 1

Discussion

Several studies established the therapeutic effect of DPCP in patients with AA, but the reported treatment responses have varied.8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 23, 24 The differences in the response rate depend not only on disease-associated factors but also on treatment-associated factors such as sensitization protocol and treatment area, duration, and interval.25, 26, 27, 28, 29 Furthermore, there are conflicting reports as to whether the presence or absence of an eczematous reaction

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  • Funding sources: None.

    Conflicts of interest: None disclosed.

    Reprints not available from the authors.

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