A small individual study of DPCP reported complete regrowth in 4 of 12 (33%) children with extensive AA; growth persisted at 6 months in 3 of the 4 responders.7 Another cohort study reported a 50% response rate (>80% regrowth) using DPCP in 10 patients (11–14 years of age) with extensive disease.8
Use SADBE and DPCP with caution
SADBE and DPCP are unlicensed treatments that can cause occipital and cervical lymphadenopathy, severe dermatitis (minimized by careful titration), urticaria, and hypo- or hyperpigmentation disorders (especially in racially pigmented patients). These agents shouldn’t be used during pregnancy and should be applied using gloves and aprons to avoid allergic contact dermatitis.
In light of these cautions, and handling and storage limitations, SADBE and DPCP should be reserved for patients with extensive disease (after obtaining signed informed consent). Patients should avoid ultraviolet light for 24 to 48 hours after application to avoid degradation of the medication.
Recommendations
The National Alopecia Areata Foundation and the American Academy of Dermatology recommend corticosteroids, topical minoxidil, and anthralin to treat AA.9,10
The British Association of Dermatologists’ guidelines for managing AA advise using intralesional corticosteroids for limited AA and contact immunotherapy for more extensive disease.1 They also note that intralesional corticosteroids are poorly tolerated and clinicians are reluctant to use contact immunotherapy in children.
Acknowledgements
The opinions and assertions contained herein are the private views of the author and are not to be construed as official, or as reflecting the views of the United States Air Force Medical Service or the US Air Force at large.