Skip to main content
Top
Published in: Dermatology and Therapy 1/2018

Open Access 01-03-2018 | Original Research

Topical Immunotherapy of Alopecia Areata: A Large Retrospective Study

Authors: Nicola Zerbinati, Cristina Esposito, Edoardo D’Este, Alberto Calligaro, Rossano Valsecchi

Published in: Dermatology and Therapy | Issue 1/2018

Login to get access

Abstract

Introduction

Topical immunotherapy is frequently used in the treatment of alopecia areata (AA) although few studies report long-term follow-up. Our goals were to determine the efficacy and the prognostic factors of topical immunotherapy in a large cohort of patients with AA treated in the departments of Dermatology and Venereology of Bergamo, Como and Pavia, from 1978 to January 2016.

Methods

A total of 252 patients with AA were evaluated retrospectively.

Results

All our patients developed an allergic reaction to a 2% solution of dinitrochlorobenzene (DNCB) or squaric acid dibutylester (SADBE) or diphenylcyclopropenone (DPCP). No patients discontinued therapy because of side effects. In total 112 patients (44.05%, p < 0.001) had a good response. Statistical analysis revealed that the main prognostic factors influencing the clinical results were the severity of hair loss at the beginning of therapy, the duration of AA, a history of atopy (particularly eczema), and the early development of sensitization to the three sensitizers.

Conclusion

Topical immunotherapy in patients with AA is quite effective, mostly well tolerated, and provides prolonged therapeutic benefits.
Literature
1.
go back to reference Dainichi T, Kabashima K. Alopecia areata: what’s new in epidemiology, pathogenesis, diagnosis, and therapeutic options? J Dermatol Sci. 2017;86:3–12.CrossRefPubMed Dainichi T, Kabashima K. Alopecia areata: what’s new in epidemiology, pathogenesis, diagnosis, and therapeutic options? J Dermatol Sci. 2017;86:3–12.CrossRefPubMed
2.
go back to reference Safavi K. Prevalence of alopecia areata in the first national health and nutrition examination survey. Arch Dermatol. 1992;128:702.CrossRefPubMed Safavi K. Prevalence of alopecia areata in the first national health and nutrition examination survey. Arch Dermatol. 1992;128:702.CrossRefPubMed
3.
go back to reference Yang S, et al. The genetic epidemiology of alopecia areata in China. Br J Dermatol. 2004;151:16–23.CrossRefPubMed Yang S, et al. The genetic epidemiology of alopecia areata in China. Br J Dermatol. 2004;151:16–23.CrossRefPubMed
4.
go back to reference Chu S-Y, et al. Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study. J Am Acad Dermatol. 2011;65:949–56.CrossRefPubMed Chu S-Y, et al. Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study. J Am Acad Dermatol. 2011;65:949–56.CrossRefPubMed
5.
go back to reference Miller R, Conic RZ, Bergfeld W, Mesinkovska NA. Prevalence of comorbid conditions and sun-induced skin cancers in patients with alopecia areata. J Investig Dermatol Symp Proc. 2015;17:61–2.CrossRefPubMed Miller R, Conic RZ, Bergfeld W, Mesinkovska NA. Prevalence of comorbid conditions and sun-induced skin cancers in patients with alopecia areata. J Investig Dermatol Symp Proc. 2015;17:61–2.CrossRefPubMed
6.
go back to reference Ruiz-Doblado S, Carrizosa A, García-Hernández MJ. Alopecia areata: psychiatric comorbidity and adjustment to illness. Int J Dermatol. 2003;42:434–7.CrossRefPubMed Ruiz-Doblado S, Carrizosa A, García-Hernández MJ. Alopecia areata: psychiatric comorbidity and adjustment to illness. Int J Dermatol. 2003;42:434–7.CrossRefPubMed
7.
go back to reference Stankler L. Synchronous alopecia areata in two siblings: a possible viral aetiology. Lancet. 1979;1:1303–4.CrossRefPubMed Stankler L. Synchronous alopecia areata in two siblings: a possible viral aetiology. Lancet. 1979;1:1303–4.CrossRefPubMed
8.
go back to reference Alsaleh QA, Nanda A, al-Hasawi F, el-Kashlan M. Concurrent appearance of alopecia areata in siblings. Pediatr Dermatol. 1995;12:285–6.CrossRefPubMed Alsaleh QA, Nanda A, al-Hasawi F, el-Kashlan M. Concurrent appearance of alopecia areata in siblings. Pediatr Dermatol. 1995;12:285–6.CrossRefPubMed
9.
go back to reference Martinez-Mir A, et al. Genomewide scan for linkage reveals evidence of several susceptibility loci for alopecia areata. Am J Hum Genet. 2007;80:316–28.CrossRefPubMedPubMedCentral Martinez-Mir A, et al. Genomewide scan for linkage reveals evidence of several susceptibility loci for alopecia areata. Am J Hum Genet. 2007;80:316–28.CrossRefPubMedPubMedCentral
10.
go back to reference Lu W, et al. Alopecia areata: pathogenesis and potential for therapy. Expert Rev Mol Med. 2006;8:1–19.CrossRefPubMed Lu W, et al. Alopecia areata: pathogenesis and potential for therapy. Expert Rev Mol Med. 2006;8:1–19.CrossRefPubMed
12.
go back to reference Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol. 2000;42:549–66 (quiz 567–570).CrossRefPubMed Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol. 2000;42:549–66 (quiz 567–570).CrossRefPubMed
13.
go back to reference Messenger AG, McKillop J, Farrant P, McDonagh AJ, Sladden M. British Association of Dermatologists’ guidelines for the management of alopecia areata 2012. Br J Dermatol. 2012;166:916–26.CrossRefPubMed Messenger AG, McKillop J, Farrant P, McDonagh AJ, Sladden M. British Association of Dermatologists’ guidelines for the management of alopecia areata 2012. Br J Dermatol. 2012;166:916–26.CrossRefPubMed
14.
go back to reference Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update. J Am Acad Dermatol. 2010;62:177–88.CrossRefPubMed Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update. J Am Acad Dermatol. 2010;62:177–88.CrossRefPubMed
15.
go back to reference Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part II. Treatment. J Am Acad Dermatol. 2010;62:191–202 (quiz 203–204).CrossRefPubMed Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part II. Treatment. J Am Acad Dermatol. 2010;62:191–202 (quiz 203–204).CrossRefPubMed
16.
go back to reference DeLeve LD. Dinitrochlorobenzene is genotoxic by sister chromatid exchange in human skin fibroblasts. Mutat Res. 1996;371:105–8.CrossRefPubMed DeLeve LD. Dinitrochlorobenzene is genotoxic by sister chromatid exchange in human skin fibroblasts. Mutat Res. 1996;371:105–8.CrossRefPubMed
17.
go back to reference Gulati N, et al. Molecular characterization of human skin response to diphencyprone at peak and resolution phases: therapeutic insights. J Invest Dermatol. 2014;134:2531–40.CrossRefPubMedPubMedCentral Gulati N, et al. Molecular characterization of human skin response to diphencyprone at peak and resolution phases: therapeutic insights. J Invest Dermatol. 2014;134:2531–40.CrossRefPubMedPubMedCentral
18.
go back to reference D’Ovidio R. Alopecia areata: news on diagnosis, pathogenesis and treatment. G Ital Dermatol Venereol. 2014;149:25–45.PubMed D’Ovidio R. Alopecia areata: news on diagnosis, pathogenesis and treatment. G Ital Dermatol Venereol. 2014;149:25–45.PubMed
19.
go back to reference Ohlmeier MC, Traupe H, Luger TA, Böhm M. Topical immunotherapy with diphenylcyclopropenone of patients with alopecia areata—a large retrospective study on 142 patients with a self-controlled design. J Eur Acad Dermatol Venereol. 2012;26:503–7.CrossRefPubMed Ohlmeier MC, Traupe H, Luger TA, Böhm M. Topical immunotherapy with diphenylcyclopropenone of patients with alopecia areata—a large retrospective study on 142 patients with a self-controlled design. J Eur Acad Dermatol Venereol. 2012;26:503–7.CrossRefPubMed
20.
go back to reference Weise K, Kretzschmar L, John SM, Hamm H. Topical immunotherapy in alopecia areata: anamnestic and clinical criteria of prognostic significance. Dermatology (Basel). 1996;192:129–33.CrossRef Weise K, Kretzschmar L, John SM, Hamm H. Topical immunotherapy in alopecia areata: anamnestic and clinical criteria of prognostic significance. Dermatology (Basel). 1996;192:129–33.CrossRef
21.
go back to reference Gordon PM, Aldridge RD, McVittie E, Hunter JAA. Topical diphencyprone for alopecia areata: evaluation of 48 cases after 30 months’ follow-up. Br J Dermatol. 1996;134:869–71.CrossRefPubMed Gordon PM, Aldridge RD, McVittie E, Hunter JAA. Topical diphencyprone for alopecia areata: evaluation of 48 cases after 30 months’ follow-up. Br J Dermatol. 1996;134:869–71.CrossRefPubMed
22.
go back to reference Firooz A, et al. Topical immunotherapy with diphencyprone in the treatment of extensive and/or long-lasting alopecia areata. J Eur Acad Dermatol Venereol. 2005;19:393–4.CrossRefPubMed Firooz A, et al. Topical immunotherapy with diphencyprone in the treatment of extensive and/or long-lasting alopecia areata. J Eur Acad Dermatol Venereol. 2005;19:393–4.CrossRefPubMed
23.
go back to reference Ajith C, Gupta S, Kanwar AJ. Efficacy and safety of the topical sensitizer squaric acid dibutyl ester in alopecia areata and factors influencing the outcome. J Drugs Dermatol. 2006;5:262–6.PubMed Ajith C, Gupta S, Kanwar AJ. Efficacy and safety of the topical sensitizer squaric acid dibutyl ester in alopecia areata and factors influencing the outcome. J Drugs Dermatol. 2006;5:262–6.PubMed
24.
go back to reference van der Steen PH, van Baar HM, Happle R, Boezeman JB, Perret CM. Prognostic factors in the treatment of alopecia areata with diphenylcyclopropenone. J Am Acad Dermatol. 1991;24:227–30.CrossRefPubMed van der Steen PH, van Baar HM, Happle R, Boezeman JB, Perret CM. Prognostic factors in the treatment of alopecia areata with diphenylcyclopropenone. J Am Acad Dermatol. 1991;24:227–30.CrossRefPubMed
25.
go back to reference McDonagh AJG, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol. 2002;27:405–9.CrossRefPubMed McDonagh AJG, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol. 2002;27:405–9.CrossRefPubMed
Metadata
Title
Topical Immunotherapy of Alopecia Areata: A Large Retrospective Study
Authors
Nicola Zerbinati
Cristina Esposito
Edoardo D’Este
Alberto Calligaro
Rossano Valsecchi
Publication date
01-03-2018
Publisher
Springer Healthcare
Published in
Dermatology and Therapy / Issue 1/2018
Print ISSN: 2193-8210
Electronic ISSN: 2190-9172
DOI
https://doi.org/10.1007/s13555-018-0226-5

Other articles of this Issue 1/2018

Dermatology and Therapy 1/2018 Go to the issue