Treatment with the topical immunotherapy diphenylcyclopropenone (DPCP) resulted in a complete response rate of 8.8% and a 61.8% rate of any hair regrowth in pediatric patients with alopecia areata (AA), according to a study published in Skin health and diseases.1
The researchers also found that the severity of the disease at the start may have influenced the overall effectiveness of the treatment.
Background and methods
The effectiveness of DPCP in hair loss has been demonstrated in several previous studies. When used alone, it has been shown to be effective in AA.2 When combined with platelet-rich plasma in cases of severe or recalcitrant AA, researchers reported a regrowth rate of 54.5% in patients treated with both therapies. In addition, they reported a comparable regrowth rate of 53.85% in patients treated with DPCP alone.3
The researchers conducted the present retrospective, single-center study from March 2016 to March 2021 in a dermatology hospital, focusing on pediatric patients with AA treated with DPCP.
Results
The cohort of 97 patients showed a slight male predominance, with 53.6% of patients being male. The mean age of participants was 11.1 years, with the majority (43.3%) falling into the 6-12 year age group. Prior treatments predominantly included topical steroids (58.1%) and minoxidil (27.4%).
After 6 months of treatment, the results showed that 51.5% of patients did not respond to treatment. The researchers observed a minimal response in 30.9% of patients, 14.4% showed a partial response, and 3.1% achieved a complete response.
At 12-month follow-up, 38.2% of patients had no response, 26.5% had minimal response, another 26.5% had partial response, and 8.8% achieved complete response.
The researchers also identified several key factors that influence treatment outcomes, including the type of alopecia, the duration of the disease, the duration of treatment, and the severity at baseline.
At 6 months, patients with patchy alopecia responded more favorably compared to patients with other types, with statistical significance observed. The researchers also found that longer disease duration of AA was associated with poorer treatment response at 6 months and then diminished at 12 months.
In addition, the duration of treatment with DPCP was a significant predictor of treatment response. Patients with longer treatment duration had better outcomes at both 6 months (15.4 months versus 12.1 months) and 12 months (19.4 months versus 13.2 months).
The Severity of Alopecia Tool (SALT) score at baseline was inversely related to treatment response. A higher initial SALT score, indicating more severe AA, was associated with a lower likelihood of a positive treatment outcome.
At 6 months, 53.6% of patients reported no complications. The most common side effects were blisters and vesicles, which occurred in 38.1% of cases. At 12-month follow-up, 55.9% of patients had complications, with blisters and vesicles remaining the most commonly reported problems.
Conclusions
The researchers noted that the results are consistent with previous research on the role of DPCP in the treatment of AA. They also underscore the importance of early measurements of disease severity and treatment adherence. The study authors recommended long-term longitudinal studies comparing DPCP treatment with other modalities.
The study may have been limited due to selection bias, limited sample size, and the single-center design of the study.
“Our results support a more integrated role for DPCP in the treatment of AA in children, in line with current clinical guidelines that typically recommend DPCP as a secondary treatment,” said Esmaeili et al. “The results underscore the need for personalized treatment approaches and continuous patient engagement to optimize treatment outcomes.”
References
- Esmaeili F, Vahabi SM, Abdoli M et al. Topical immunotherapy with diphenylcyclopropenone in pediatric patients with alopecia areata – a retrospective study of 97 patients. Skin health disease. August 19, 2024. https://doi.org/10.1002/ski2.441
- JP Cardia, PA Pavco, WR Levis. Diphencyprone treatment of alopecia areata: postulated mechanism of action and prospects for therapeutic synergy with RNA interference. Proceedings of the Journal of Investigative Dermatology. Elsevier; 2015.
- Abd El-Magid WM, Mohamed RAE, Elsharkawy REE. Diphenylcyclopropenone and platelet-rich plasma in the treatment of severe or recalcitrant alopecia areata. J Cosmet Dermatol. 2023; 22(11): 2971–2981.
