Sisaipho alopecia areata
A 2004 study by tang et al 28 showed no benefit appelazijn in using anthralin. Other studies showed a response rate of 20-75, respectively, for patchy alopecia areata and a 25 response rate for alopecia totalis. The mean time to response was 11 weeks, and the mean time to cosmetic response was 23 weeks. Anthralin was used by tang et al in balding C3H/hej mice, which is one animal model for alopecia areata. Half the body was treated with anthralin.2, while the other side was treated with the vehicle ointment. Regrowth was seen on the treated side in 64 of mice after 10 weeks. Four mice had almost complete regrowth. The untreated side showed either no regrowth or continued hair loss. Cytokine studies performed with an rnase protection assay showed that tumor necrosis factor-alpha and -beta were inhibited in mice that responded to treatment. Most patients experienced irritant contact dermatitis. Whether the dermatitis is necessary for efficacy remains under debate. Cosmetically acceptable regrowth was maintained during therapy in 71 of responders.
Alopecia - dermatologic Disorders - merck manuals
Treating only half of the growth head allows the physician to use the untreated half as a control. Once regrowth occurs on the treated half, treatment can be applied to the entire scalp. If regrowth initially occurs on both sides, spontaneous remission is likely, although treatment cannot be excluded as the cause. Avoid severe contact dermatitis. Patients are advised to avoid light exposure on the scalp for 48 hours because light degrades the chemical. Patients also are advised not to wash the scalp for 48 hours. Initial regrowth may be seen at weeks 12-24. Once cosmetically acceptable regrowth is achieved, the treatment can be tapered gradually. Almost all patients relapse if the treatment is discontinued, and maintenance treatment is needed. Anthralin The efficacy of anthralin was assessed in 3 studies, which unfortunately were uncontrolled. Both short-contact and overnight treatments have been used. Anthralin concentrations varied from.2-1.
naive patient, it is best to seek approval for the treatment by the ethics review board and to have the patient sign an informed consent. Both sadbe and dpcp appear to be equally effective. Acetone-based solutions usually are preferred because they evaporate quickly, allowing patients to wear a hat or wig immediately after treatment. Quick drying also decreases the chances of dissemination to other body parts by contact. Treatment is provided weekly. The patient first is sensitized directly on the scalp with a 2 concentration on a small area (2 cm). The following week, a low concentration (0.0001) is applied. The concentration is increased slowly every week as needed until a mild tolerable allergic contact dermatitis is elicited. Many concentrations are available that achieve this goal.
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Topical immunotherapy has been used for almost 20 years; no serious adverse effects have been reported. The most common side effect, which is desired, is a mild contact dermatitis (redness, scaling, itching). Adverse effects include cervical lymphadenopathy and pigment changes. Vitiligo developed on the application site.7-7.5 of hair patients. Transient leukoderma on a distant untreated area has been reported. Of patients who develop vitiligo, 31 (4 of 13) had a history of vitiligo. Only.75 of patients developed hyperpigmentation. Confetti-type dyschromia (ie, hyperpigmentation, hypopigmentation) has been described as an adverse effect of dpcp treatment and occurred.6 of 243 patients treated. Less common adverse effects include erythema multiformelike eruptions and urticaria, which were reported in 3 patients treated with dpcp. The mechanism of action of topical immunotherapy is unknown. Antigenic competition has been hypothesized.
The relapse rate after reaching significant regrowth was.6. In a report of a 5-year experience with the use of dpcp, 97 subjects received continued therapy with dpcp. A response rate of greater than 75 was seen in 15 at 6 months, 49 at 12 months, 53 at 18 months, and 56 at 24 months. The only variable that seemed to affect response to treatment was the baseline extent of the alopecia areata. A greater than 75 response rate was seen in 100 of patients with 25-49 hair loss at baseline, 77 of those with 50-74 loss at baseline, 54 of those with 75-99 loss at baseline, 50 of alopecia totalis patients, and 41 of alopecia universalis patients. Maintenance treatment (once every 1-4 wk) appeared to reduce the risk of relapse ( 25 hair loss). Only 18 of patients experienced relapse on maintenance therapy, compared with 57 in those who discontinued treatment. 27, the type of alopecia areata before treatment, duration of the disease, and the presence of nail changes were found to predict a lower response to treatment. Age at onset and sex of the patient do not appear to influence the prognosis. Controversy exists concerning whether atopy is an adverse prognosis factor.
May iotaderma 255) - journal of the American AcademyNo formal data are available on dpcp regarding its longevity in solution. Cosmetically acceptable regrowth with topical immunotherapy rates in patients with severe alopecia areata ( 50 involvement) varies from 22-68. Most studies have a success rate of 30-50. Wiseman et al 26 retrospectively reported the results of a large cohort of 148 consecutive patients treated with dpcp. Their analysis showed that the cumulative patient response at 32 months was.9. The response rate varied with the extent of the alopecia. Cosmetically acceptable regrowth was seen.4 of patients with alopecia totalis or alopecia universalis,.3 in patients with 75-99 hair loss,.1 in patients with 50-74 hair loss, and 100 regrowth in those with 25-49 hair loss. Age at onset was also a significant variable, with older age at onset leading to a better prognosis. A lag period of 3 months was usually curly present between the onset of therapy and the presence of regrowth. The median time to achieve significant regrowth was.2 months. Some patients showed regrowth on the treated side after 18 months of therapy. No benefit is achieved with continuing therapy after 24 months in the absence of regrowth.
Telangiectases and local atrophy also have been reported. No systemic adverse effects have been reported. Immunotherapy, topical immunotherapy 1 is defined as the induction and periodic elicitation of an allergic contact dermatitis by topical application of potent contact allergens. Commonly used agents for immunotherapy include squaric acid dibutylester (sadbe) and diphencyprone (dpcp). 2, these 2 sensitizers are not present in the natural or industrial environment. These are compounded investigational agents not approved by the us food and Drug Administration for use in alopecia. Dinitrochlorobenzene (dncb) has become less popular as a result of reports that it is mutagenic in the Ames assay (a bacterial assay). No rigorous toxicologic and pharmacologic studies have been performed on the use of these agents in humans. Although dpcp and sadbe have not been found mutagenic in the Ames assay, neither is approved by the us food and Drug Administration, and unknowns still exist concerning their safety profiles. No contaminants consumer have been found in sadbe. Acetone solutions and alcohol solutions of sadbe are equally stable for 2 months under storage conditions. Dpcp occasionally can contain mutagenic contaminants; therefore, it should be screened periodically to ensure purity.
Alopecia areata Clinical Presentation: History, physical
24, although injections may work in extensive alopecia areata, results are unlikely if no response is observed at 6 months (personal observation). For topical steroids, again, few studies have been performed regarding efficacy in the treatment of alopecia areata; they can however be useful, especially in children who cannot tolerate injections. Fluocinolone acetonide cream.2 (Synalar HP) twice per day induced a satisfactory-to-excellent response in 61 of patients, which was maintained in 71 of patients. Children younger than 10 years responded better, as did patients with a duration of hair loss of less than 1 year. Betamethasone dipropionate cream.05 (Diprosone) showed similar efficacy. A 2005 study by tosti et al 25 in patients with alopecia totalis or alopecia universalis showed that the use.5 g of clobetasol propionate under occlusion with a plastic film 6 d/wk for 6 months induced regrowth in 8 (28.5) of 28 patients. Regrowth was seen 6-14 weeks after the onset of therapy. Regrowth was maintained for at least 6 months after cessation of therapy maart in 5 (62.5) of 8 patients. Even though only.8 of patients showed long-term benefits from that treatment, it should be kept in mind that the study was performed in a subgroup of patients that is usually refractory to treatment. Treatment must be continued for a minimum of 3 months before regrowth can be expected, and maintenance therapy often is necessary. Despite these data, the authors do not believe that monotherapy with a topical steroid has been of great benefit in the authors' practice. The most common adverse effect is local folliculitis, which appears after a few weeks of treatment.
A 2015 study showed no difference in doen regrowth when using.5 mg/mL, 5 mg/ml, or 10 mg/mL and all were superior to placebo. Although all concentrations were well tolerated, more cases of reversible skin atrophy were seen in the 10-mg/ml group. 23, the lowest concentration should always be used on the face to avoid skin atrophy. Caution should be used in patients with glaucoma when treating the eyebrows. It may be best to consult with their ophthalmologists. Less than.1 mL is injected per site, and injections are spread out to cover the affected areas (approximately 1 cm between injection sites; see image below). Adverse effects mostly include pain during injection and minimal transient atrophy (10). The presence of atrophy should prompt a reduction in the triamcinolone acetonide concentration and avoidance of the atrophic site. Injections are administered every 4-6 weeks. Although intralesional injections of triamcinolone acetonide are usually recommended for alopecia areata with less than 50 involvement, a report showed that 6 of 10 patients had regrowth.
Alopecia areata Treatment & Management: Approach
Corticosteroids, corticosteroid therapies can include intralesional injections or topical application. Intralesional steroids, for intralesional steroids, few studies are long available regarding efficacy; however, they are used widely in the treatment of alopecia areata. Intralesional steroids are the first-line treatment in localized conditions and are usually superior to topical corticosteroids. 22, in a study including 84 patients, regrowth on treated areas was present in 92 of patients with patchy alopecia areata and 61 of patients with alopecia totalis. Regrowth persisted 3 months after treatment in 71 of patients with patchy alopecia areata and 28 of patients with alopecia totalis. Regrowth usually is seen within 4-6 weeks in responsive patients. Patients with rapidly progressive, extensive, or long-standing alopecia areata tend to respond poorly. Another study showed regrowth in most patients (480) treated with intralesional steroids, except in two patients with alopecia universalis. Hair growth may persist for 6-9 months after a single injection. Injections are administered intradermally using a 3-mL syringe and a 30-gauge needle. Triamcinolone acetonide (Kenalog) is used most commonly; concentrations vary from.5-10 mg/mL. The lowest concentration is used on the face.