TREATMENT OF CHRONIC SEVERE ALOPECIA-AREATA WITH TOPICAL DIPHENYLCYCLOPROPENONE AND 5-PERCENT MINOXIDIL - A CLINICAL AND IMMUNOPATHOLOGIC EVALUATION

Background: Topical diphenylcyclopropenone (DPCP) and minoxidil have b een used in the treatment of alopecia areata with variable results. Ob jective: This study was designed to evaluate the efficacy of DPCP alon e or in combination with topical 5% minoxidil for the treatment of chr onic severe alopecia areata. The effect of therapy on cutaneous T-cell and Langerhans cell subpopulations and intercellular adhesion molecul e-1 (ICAM-1) expression was also examined. Methods: Fifteen patients w ith chronic (more than 2 years), severe (more than 50% scalp involveme nt) alopecia areata participated in a 24-week trial. Half of the scalp was treated with DPCP once weekly and with either 5% minoxidil soluti on or a vehicle solution twice daily in a randomized double-blind desi gn. Skin biopsy specimens from each half of the scalp were obtained be fore therapy and after 12 and 24 weeks of therapy for histologic and i mmunophenotypic analysis. Results: Thirteen patients completed the stu dy. Five of 13 patients (38%) showed marked regrowth of coarse termina l 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, Le u-2, Leu-3, and keratinocyte ICAM-1 expression were significantly redu ced in biopsy specimens of responders versus nonresponders. Conclusion : DPCP treatment showed a 38% success rate in producing cosmetically a cceptable regrowth in patients with chronic severe alopecia areata.