How to treat alopecia areata: Topical Immunotherapy

Alopecia areata is the autoimmune disease that can lead to hair loss. Since this is an autoimmune disease, it is the body's own immune system that is attacking the hair follicles. It sometimes appears as mild and patchy hair loss but if more than half of your head is affected, hair loss has reoccurred many times, hair loss has persisted for over a year or incidences of hair loss began in childhood, it is usually considered severe. Treatment can be difficult, especially in the more severe cases. There are currently no approved therapies as success rates have varied with individual cases but good results are possible¹.

For these severe cases, topical immunotherapy is often used^2,3. A sensitizing agent (usually diphenylcyclopropenone or squaric acid dibutylester) is applied to the scalp to cause an allergic reaction⁴. It is not completely understood why this reaction causes the immune system to stop attacking hair follicles although it is believed that the appearance of a new immune target or an increase in cells that regulate the immune response could be contributing factors⁵.

Be prepared for possible side effects which include a burning sensation, blistering, irritation, darkening of the skin, enlargement of the lymph nodes, itchy rash, facial swelling, redness^6,7 and brown patches⁸. The second downside to this type of treatment is that relapses are not uncommon¹.

Topical immunotherapy is usually not recommended for pregnant women⁹, use in eyebrows¹⁰ or for those with mild¹¹ or rapidly expanding alopecia areata¹². This treatment is also less likely to be successful in those with complete hair loss, those experiencing body hair loss, those that have experienced thyroid disease or those that have affected nails^1,7,10. If you are interested in learning more about topical immunotherapy for your alopecia areata, speak with your doctor or hair restoration expert.

Article by: Dr. J.L. Carviel, PhD, Mediprobe Research Inc.

References

1. Rokhsar CK, Shupack JL, Vafai JJ, Washenik K. Efficacy of topical sensitizers in the treatment of alopecia areata. J Am Acad Dermatol. 1998 Nov;39(5 Pt 1):751–61.


2. Wiseman MC, Shapiro J, MacDonald N, Lui H. Predictive model for immunotherapy of alopecia areata with diphencyprone. Arch Dermatol. 2001 Aug;137(8):1063–8.


3. Ro BI. Alopecia areata in Korea (1982-1994). J Dermatol. 1995 Nov;22(11):858–64.


4. Orecchia G, Perfetti L. Alopecia areata and topical sensitizers: allergic response is necessary but irritation is not. Br J Dermatol. 1991 May;124(5):509.


5. Happle R. Antigenic competition as a therapeutic concept for alopecia areata. Arch Dermatol Res. 1980;267(1):109–14.


6. Pan R, Liu J, Xuan X, Li B. Chinese experience in the treatment of alopecia areata with diphenylcyclopropenone. J Dermatol. 2015 Feb;42(2):220–1.


7. Chiang K, Atanaskova Mesinkovska N, Amoretti A, Piliang MP, Kyei A, Bergfeld WF. Clinical efficacy of diphenylcyclopropenone in alopecia areata: retrospective data analysis of 50 patients. J Am Acad Dermatol. 2014 Sep;71(3):595–7.


8. Tosti A, Piraccini BM, Misciali C, Vincenzi C. Lentiginous eruption due to topical immunotherapy. Arch Dermatol. 2003 Apr;139(4):544–5.


9. Wilkerson MG, Connor TH, Henkin J, Wilkin JK, Matney TS. Assessment of diphenylcyclopropenone for photochemically induced mutagenicity in the Ames assay. J Am Acad Dermatol. 1987 Oct;17(4):606–11.


10. van der Steen PH, Happle R. Topical immunotherapy of alopecia areata. Dermatol Clin. 1993 Jul;11(3):619–22.


11. Tosti A, De Padova MP, Minghetti G, Veronesi S. Therapies versus placebo in the treatment of patchy alopecia areata. J Am Acad Dermatol. 1986 Aug;15(2 Pt 1):209–10.


12. Iorizzo M, Tosti A. Treatments options for alopecia. Expert Opin Pharmacother. 2015;16(15):2343–54.

 

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