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Treatment of chronic severe alopecia areata with topical diphenylcyclopropenone and 5% minoxidil: A clinical and immunopathologic evaluation

1993; Elsevier BV; Volume: 29; Issue: 5 Linguagem: Inglês

10.1016/0190-9622(93)70238-o

1097-6787

Jerry Shapiro, Jerry Tan, Vincent Ho, Frank Abbott, Victor A. Tron,

Dermatology and Skin Diseases

Background: Topical diphenylcyclopropenone (DPCP) and minoxidil have been used in the treatment of alopecia areata with variable results. Objective: This study was designed to evaluate the efficacy of DPCP alone or in combination with topical 5% minoxidil for the treatment of chronic severe alopecia areata. The effect of therapy on cutaneous T-cell and Langerhans cell subpopulations and intercellular adhesion molecule—1 (ICAM-1) expression was also examined. Methods: Fifteen patients with chronic (more than 2 years), severe (more than 50% scalp involvement) alopecia areata participated in a 24-week trial. Half of the scalp was treated with DPCP once weekly and with either 5% minoxidil solution or a vehicle solution twice daily in a randomized double-blind design. Skin biopsy specimens from each half of the scalp were obtained before therapy and after 12 and 24 weeks of therapy for histologic and immunophenotypic analysis. Results: Thirteen patients completed the study. Five of 13 patients (38%) showed marked re-growth of coarse terminal hair after 24 weeks of treatment with DPCP. The addition of topical 5% minoxidil did not produce any significant clinical benefit in this 24-week trial. Immunophenotypic analysis showed no differences between responders and nonresponders at baseline. During treatment, Leu-4, Leu-2, Leu-3, and keratinocyte ICAM-1 expression were significantly reduced in biopsy specimens of responders versus nonresponders. Conclusion: DPCP treatment showed a 38% success rate in producing cosmetically acceptable regrowth in patients with chronic severe alopecia areata.