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


CONCLUSIONS
DPCP treatment showed a 38% success rate in producing cosmetically acceptable regrowth in patients with chronic severe alopecia areata.
Shapiro
J
J
Division of Dermatology, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Tan
J
J
Ho
V
V
Abbott
F
F
Tron
V
V
D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000505:Alopecia / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D000911:Antibodies, Monoclonal; D015703:Antigens, CD / Q000096:biosynthesis / Q000187:drug effects; D015704:CD4 Antigens / Q000096:biosynthesis / Q000187:drug effects; D016827:CD8 Antigens / Q000096:biosynthesis / Q000187:drug effects; D015815:Cell Adhesion Molecules / Q000096:biosynthesis / Q000187:drug effects; D002908:Chronic Disease; D003521:Cyclopropanes / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D018799:Intercellular Adhesion Molecule-1; D015603:Keratinocytes / Q000187:drug effects / Q000378:metabolism; D007801:Langerhans Cells / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D008914:Minoxidil / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016176:T-Lymphocyte Subsets / Q000187:drug effects / Q000378:metabolism / Q000473:pathology
D000911:Antibodies, Monoclonal; D015703:Antigens, CD; D015704:CD4 Antigens; D016827:CD8 Antigens; D015815:Cell Adhesion Molecules; D003521:Cyclopropanes; D018799:Intercellular Adhesion Molecule-1; D008914:Minoxidil; C029402:diphenylcyclopropenone