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01-10-2019 | Alopecia | Original Paper

Efficacy and safety of anthralin in combination with diphenylcyclopropenone in the treatment of alopecia areata: a retrospective case series

Authors: Maryam Nasimi, Narges Ghandi, Robabeh Abedini, Azadeh Mirshamsi, Safoura Shakoei, Hassan Seirafi

Published in: Archives of Dermatological Research | Issue 8/2019

Abstract

Contact immunotherapy with diphenylcyclopropenone (DPCP) and anthralin is considered the treatment option for extensive alopecia areata (AA) unresponsive to DPCP immunotherapy alone. Only one study has described the efficacy of combination therapy; therefore, we investigated whether topical DPCP and anthralin can promote hair regrowth in DPCP-non responders. In this retrospective case-series we analyzed the efficacy and side effects of DPCP with anthralin in AA patients who did not respond to several months of treatment with DPCP alone. Thirty-two DPCP-nonresponsive AA patients were treated with DPCP and anthralin for the average of 8.3 ± 3.8 (3–17) months. During the treatment, 40.62% of patients (13 patients out of 32) had terminal hair regrowth. The mean of hair regrowth rate was 41%; it was mainly as partial hair regrowth (˂ 50%) and 27.27% of cases achieved > 50% terminal hair regrowth. Treatment response strongly related to the duration of combination therapy (p value ˂ 0.001), but we did not find any relation with other demographic characteristics. The first signs of response to treatment were noticed 2–12 months (5.5 ± 3.4) after initiation of combination therapy while there was a positive correlation among the duration of treatment and percentage of hair regrowth (p < 0.001). The most common complication was bullae (25%), and the least frequent side effect was generalized pruritus (3.1%). The combination therapy with DPCP and anthralin could be effective to treat DPCP non-responder AA patients. Additionally, the higher treatment response could be achieved by longer treatment duration.

Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J (2010) Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol 62:177–188. https://doi.org/10.1016/j.jaad.2009.10.032 (Quiz 189–190) CrossRefPubMed

Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J (2010) Alopecia areata update: part II. Treatment. J Am Acad Dermatol 62:191–202. https://doi.org/10.1016/j.jaad.2009.10.031 (Quiz 203–194) CrossRefPubMed

Berth-Jones J, Hutchinson PE (1991) Treatment of alopecia totalis with a combination of inosine pranobex and diphencyprone compared to each treatment alone. Clin Exp Dermatol 16:172–175CrossRefPubMed

Buckley DA, Du Vivier AW (2001) The therapeutic use of topical contact sensitizers in benign dermatoses. Br J Dermatol 145:385–405CrossRefPubMed

Dall’oglio F, Nasca MR, Musumeci ML, La Torre G, Ricciardi G, Potenza C, Micali G (2005) Topical immunomodulator therapy with squaric acid dibutylester (SADBE) is effective treatment for severe alopecia areata (AA): results of an open-label, paired-comparison, clinical trial. J Dermatol Treat 16:10–14. https://doi.org/10.1080/09546630410023601 CrossRef

Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J (2008) Interventions for alopecia areata. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd004413.pub2 CrossRefPubMed

Durdu M, Özcan D, Baba M, Seçkin D (2015) Efficacy and safety of diphenylcyclopropenone alone or in combination with anthralin in the treatment of chronic extensive alopecia areata: a retrospective case series. J Am Acad Dermatol 72:640–650. https://doi.org/10.1016/j.jaad.2015.01.008 CrossRefPubMed

Gregoriou S, Papafragkaki D, Kontochristopoulos G, Rallis E, Kalogeromitros D, Rigopoulos D (2010) Cytokines and other mediators in alopecia areata. Media Inflamm 2010:928030. https://doi.org/10.1155/2010/928030 CrossRef

Happle R, Hausen BM, Wiesner-Menzel L (1983) Diphencyprone in the treatment of alopecia areata. Acta Dermato Venereol 63:49–52

10.

Herbst V, Zoller M, Kissling S, Wenzel E, Stutz N, Freyschmidt-Paul P (2006) Diphenylcyclopropenone treatment of alopecia areata induces apoptosis of perifollicular lymphocytes. Eur J Dermatol 16:537–542PubMed

11.

Hunt N, McHale S (2005) The psychological impact of alopecia. BMJ 331:951–953. https://doi.org/10.1136/bmj.331.7522.951 (Clinical research ed) CrossRefPubMedPubMedCentral

12.

Jang YH, Jung HJ, Moon SY, Lee WJ, Lee SJ, Lee WK, Kim DW (2017) Systematic review and quality analysis of studies on the efficacy of topical diphenylcyclopropenone treatment for alopecia areata. J Am Acad Dermatol 77:170–172.e171. https://doi.org/10.1016/j.jaad.2017.03.015 CrossRefPubMed

13.

Lamb RC, Young D, Holmes S (2016) Retrospective review of diphencyprone in the treatment of alopecia areata. Clin Exp Dermatol 41:352–358. https://doi.org/10.1111/ced.12776 CrossRefPubMed

14.

Messenger AG, McKillop J, Farrant P, McDonagh AJ, Sladden M (2012) British association of dermatologists’ guidelines for the management of alopecia areata 2012. Br J Dermatol 166:916–926. https://doi.org/10.1111/j.1365-2133.2012.10955.x CrossRefPubMed

15.

Muthuvel K (2011) Practicality in using diphenyl cyclo propenone for alopecia areata. Int J Trichol 3:96–97. https://doi.org/10.4103/0974-7753.90816 CrossRef

16.

Ngwanya MR, Gray NA, Gumedze F, Ndyenga A, Khumalo NP (2017) Higher concentrations of dithranol appear to induce hair growth even in severe alopecia areata. Dermatol Ther 30:e12500. https://doi.org/10.1111/dth.12500 CrossRef

17.

Karanovic S, Harries M, Kaur MR (2018) Diphenylcyclopropenone for alopecia areata: a UK survey. Br J Dermatol 179:514–515. https://doi.org/10.1111/bjd.16489 CrossRefPubMed

18.

Schmoeckel C, Weissmann I, Plewig G, Braun-Falco O (1979) Treatment of alopecia areata by anthralin-induced dermatitis. Arch Dermatol 115:1254–1255CrossRefPubMed

19.

Shapiro J, Tan J, Ho V, Abbott F, Tron V (1993) Treatment of chronic severe alopecia areata with topical diphenylcyclopropenone and 5% minoxidil: a clinical and immunopathologic evaluation. J Am Acad Dermatol 29:729–735CrossRefPubMed

20.

Sotiriadis D, Patsatsi A, Lazaridou E, Kastanis A, Vakirlis E, Chrysomallis F (2007) Topical immunotherapy with diphenylcyclopropenone in the treatment of chronic extensive alopecia areata. Clin Exp Dermatol 32:48–51. https://doi.org/10.1111/j.1365-2230.2006.02256.x CrossRefPubMed

21.

Spano F, Donovan JC (2015) Alopecia areata: part 2: treatment. Can Fam Physician 61:757–761PubMedPubMedCentral

22.

Sriphojanart T, Khunkhet S, Suchonwanit P (2017) A retrospective comparative study of the efficacy and safety of two regimens of diphenylcyclopropenone in the treatment of recalcitrant alopecia areata. Dermatol Rep. https://doi.org/10.4081/dr.2017.7399 CrossRef

23.

Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, Shapiro J (2018) Alopecia areata: an appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol 78:15–24. https://doi.org/10.1016/j.jaad.2017.04.1142 CrossRefPubMed

24.

Tang L, Cao L, Pelech S, Lui H, Shapiro J (2003) Cytokines and signal transduction pathways mediated by anthralin in alopecia areata-affected Dundee experimental balding rats. J Investig Dermatol Symp Proc 8:87–90. https://doi.org/10.1046/j.1523-1747.2003.12178.x CrossRefPubMed

25.

Tang L, Cao L, Sundberg JP, Lui H, Shapiro J (2004) Restoration of hair growth in mice with an alopecia areata-like disease using topical anthralin. Exp Dermatol 13:5–10. https://doi.org/10.1111/j.0906-6705.2004.00098.x CrossRefPubMed

26.

Tang L, Sundberg JP, Lui H, Shapiro J (2003) Old wine in new bottles: reviving old therapies for alopecia areata using rodent models. J Investig Dermatol Symp Proc 8:212–216. https://doi.org/10.1046/j.1087-0024.2003.00812.x CrossRefPubMed

27.

Wasylyszyn T, Borowska K (2017) Possible advantage of imiquimod and diphenylcyclopropenone combined treatment versus diphenylcyclopropenone alone: an observational study of nonresponder patients with alopecia areata. Australas J Dermatol 58:219–223. https://doi.org/10.1111/ajd.12478 CrossRefPubMed

28.

Wasylyszyn T, Kozlowski W, Zabielski SL (2007) Changes in distribution pattern of CD8 lymphocytes in the scalp in alopecia areata during treatment with diphencyprone. Arch Dermatol Res 299:231–237. https://doi.org/10.1007/s00403-007-0759-4 CrossRefPubMed

29.

Yoshimasu T, Furukawa F (2016) Modified immunotherapy for alopecia areata. Autoimmun Rev 15:664–667. https://doi.org/10.1016/j.autrev.2016.02.021 CrossRefPubMed

Title: Efficacy and safety of anthralin in combination with diphenylcyclopropenone in the treatment of alopecia areata: a retrospective case series
Authors: Maryam Nasimi
Narges Ghandi
Robabeh Abedini
Azadeh Mirshamsi
Safoura Shakoei
Hassan Seirafi
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Keywords: Alopecia
Alopecia Areata
Pruritus
Published in: Archives of Dermatological Research / Issue 8/2019
Print ISSN: 0340-3696
Electronic ISSN: 1432-069X
DOI: https://doi.org/10.1007/s00403-019-01940-x

Keynote webinar | Spotlight on medication adherence

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Efficacy and safety of anthralin in combination with diphenylcyclopropenone in the treatment of alopecia areata: a retrospective case series

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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