title: Modified immunotherapy for alopecia areata.
abstract: Squaric acid dibutylester (SADBE) is a commonly used contact sensitizer in immunotherapy for alopecia areata (AA). Severe contact dermatitis is induced by the currently high recommended sensitization dose of 1%-2% SADBE, often decreasing patient compliance. We assessed a modified immunotherapy for AA using SADBE at a starting concentration of 0.01% without sensitization. After one or two weeks of initial 0.01% SADBE application, the concentration of SADBE was increased gradually to 0.025%, 0.05%, 0.1%, 0.25%, 0.5%, 1% and 2% until the patients felt itching or erythema at the AA lesion site. The modified immunotherapy showed a response rate of 69.4% (25/36), equivalent to conventional immunotherapy using SADBE starting at 1%-2% sensitization. Furthermore, we investigated the combination therapy of SADBE and multiple courses of steroid pulses for AA. The response rate for combination therapy was 73.7% (28/38); however, the group receiving combination therapy showed a significant prevalence of severe AA compared with the group receiving modified immunotherapy only. We reviewed the efficacy and safety of modified immunotherapy without initial sensitization and combination therapy with immunotherapy and multiple courses of pulses for AA.
authors.affiliation: Department of Dermatology, Wakayama Medical University, Japan; Department of Dermatology, Arida Municipal Hospital, Japan. Electronic address: yosshii8@jg8.so-net.ne.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshimasu
authors.affiliation: Department of Dermatology, Wakayama Medical University, Japan.
authors.forename: Fukumi
authors.initials: F
authors.lastname: Furukawa
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000506:Alopecia Areata / Q000276:immunology / Q000628:therapy*; D015551:Autoimmunity; D003131:Combined Modality Therapy; D003503:Cyclobutanes / Q000008:administration & dosage; D006801:Humans; D007167:Immunotherapy
chemical_list: D000276:Adjuvants, Immunologic; D003503:Cyclobutanes; C020637:squaric acid dibutyl ester
keywords: Alopecia areata; DPCP; Immunotherapy; Pulse; SADBE