Alopecia areata: Pathogenesis, clinical features, diagnosis, and management
Jerry Shapiro, Nina Otberg in Hair Loss and Restoration, 2015
DPCP is not mutagenic in the Ames test, and teratogenicity and organ toxicity could not be detected in the hen’s egg test or in the mouse teratogenicity test [231]. Analysis on serum and urine samples following application of at least 0.5 mL of a 1% solution of diphencyprone to the scalp of 18 patients under treatment for AA revealed no detectable amounts of diphencyprone in any sample of serum or urine from these subjects. These data suggest that diphencyprone is not absorbed following application to the skin [232]. Commercial DPCP may contain a precursor, dibromoketone, that is positive in the Ames test [233,234]. It is therefore recommended that all DPCP samples be purified as described by van der Steen et al. [231] or that a pharmaceutical chemist perform high-pressure liquid chromatography on the DPCP sample to ensure that there are no detectable amounts of this dibromoketone compound. DPCP is degradable upon exposure to light, and must be stored in amber bottles. At our clinic, DPCP is dissolved in acetone and stored away from the staff in the refrigerator in a special container.
Hair and nail disorders
Rashmi Sarkar, Anupam Das, Sumit Sethi in Concise Dermatology, 2021
Patients with a solitary patch or few patches usually do not need treatment. When the patches coalesce to become a problem cosmetically or when there is alopecia totalis, treatment is often required by patients. Intradermal injections of potent corticosteroids (typically 10 mg/mL triamcinolone) are the most effective therapy, although overuse may lead to skin atrophy. It is reasonable to inject the affected skin at 1 cm intervals, and, if necessary, repeat after a period of 3 weeks. Other less effective treatments include potent topical steroids or systemic steroids; photochemotherapy with longwave ultraviolet irradiation (PUVA); dithranol; and allergic sensitization with diphencyprone. Even topical minoxidil has been claimed to be partially successful. All of the preceding have inconvenient side effects and usually work only while they are being given. Allergic sensitization with 1% diphencyprone causes an eczematous response and ‘kicks’ the follicles back to life in about half the patients. Some patients, having experienced the side effects and frustration of the lack of efficacy of the treatments, decide to cut their losses and disguise their disability with a wig. Sympathy and support are the most useful tools for this depressing disorder.
Management of noncicatricial circumscribed alopecia
Pierre Bouhanna, Eric Bouhanna in The Alopecias, 2015
In a retrospective study of 68 patients with severe alopecia areata (>40% scalp hair loss) treated for at least 5 months with topical diphenylcyclopropenone (DCP), Pericin and Trüeb9 found an overall response rate of 70.6%, with 30.9% complete remission and 39.7% partial remission. Among the investigated prognostic factors for the outcome of DCP therapy, only the extent of alopecia areata at the time of initiation of treatment was found to be of significance. Total remission rates were as follows: for multilocular alopecia areata were 43.8%, for subtotal alopecia areata and ophiasis 33.3%, and for alopecia totalis or universalis 21.4%, irrespective of disease duration.
Laser ablation and topical drug delivery: a review of recent advances
Published in Expert Opinion on Drug Delivery, 2019
Chien-Yu Hsiao, Shih-Chun Yang, Ahmed Alalaiwe, Jia-You Fang
The fractional PLEASE® laser system was also applied to facilitate 3-fluoroamphetamine delivery through cadaver human skin [53]. The indication of this dopamine/norepinephrine releaser is the treatment of cocaine dependency and cocaine-use disorder [54]. The laser produced microchannels with the depth and diameter of 250 and 274 μm, respectively. The permeation of 3-fluoroamphetamine through laser-ablated skin was 523 μg/cm2, which was 508 times that of passive permeation. Lee et al. found that the Er:YAG laser could increase the follicular uptake of antialopecia drugs [55]. The laser ablation with the depths of 6 and 10 μm in pigskin enhanced minoxidil deposition from 1.0 (passive delivery) to 9.0 and 6.7 μg/g, respectively. In the case of diphencyprone, the skin deposition was increased from 11.4 to 20.4 and 18.4 μg/g after the 6- and 10-μm ablation, respectively. The laser raised diphencyprone uptake in hair follicles sixfold compared to passive control. The confocal imaging confirmed the large distribution of the dye in follicles after laser irradiation. The results indicate that the Er:YAG laser was also functional to propagate the ablation effect into the epidermal layer of hair follicles for increasing antialopecia drug targeting.
Translational impact of omics studies in alopecia areata: recent advances and future perspectives
Published in Expert Review of Clinical Immunology, 2022
F. Buket Basmanav, Regina C. Betz
Immunosuppression via topical, intralesional or systemic corticosteroids has been for a long time the first line of therapy. Another conventional treatment is contact immunotherapy whereby a potent allergen, such as diphenylcyclopropenone, is applied to a small area on the scalp sensitizing the patient which is followed by application of this allergen in a sufficient concentration to induce a mild contact dermatitis. The mode of action for this therapeutic modality is unknown but different mechanisms were proposed such an ‘antigenic competition’ attracting CD4 + T cells away from the perifollicular region. Both the use and the efficacy of these treatments depend on the patient’s age, the extent of disease and duration of disease as detailed elsewhere [11,99–102]. While topical and intralesional corticosteroids show moderate to high efficacies for patchy AA of limited extent (reaching up to more than 80%) and the former is the main choice for pediatric patients, they remain to be inferior options for acute and rapidly progressing cases of AA and those with a disease duration more than 6 months [103]. Systemic corticosteroids are a common choice of treatment for extensive and rapidly progressing AA especially during the acute progressive stage. However, relapse rates after cessation are high and their use over long time is associated with adverse effects and necessitates a stringent patient monitoring. Contact immunotherapy can be a choice of treatment for patchy as well as extensive long-standing AA with moderate to high efficacies reported (ranging from 55 in AT/AU to 74.6% in patchy AA) but is also not favored for acute and rapidly progressive disease and recurrence rates during maintenance treatment (38.3%) and after cessation of therapy were reported to be 38.3% and 49%, respectively [104,105].
Therapeutic outcome of diphencyprone and its correlation with serum cytokine profile in alopecia areata
Published in Journal of Dermatological Treatment, 2022
Rakhavi P. Manimaran, Sivaranjini Ramassamy, Medha Rajappa, Laxmisha Chandrashekar
The treatment for alopecia areata is based on the type and extent of the disease. Diphencyprone (DPCP) is considered as the first line of management in severe and extensive alopecia (> 50% of scalp surface area). There are multiple reports of its use in patchy alopecia and extensive alopecia (>30% of scalp surface area) areata (4). The efficacy ranges from 5% to 85%, with relapse rates ranging from 10.6% to 68.9% in patients with alopecia areata (5).
Related Knowledge Centers
- Alopecia Areata
- Aromaticity
- Benzophenone
- Thionyl Chloride
- Topical Medication
- Alopecia Totalis
- Carbonyl Group
- Resonance
- Cyclopropenone