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Diphenylcyclopropenone (DCP) as a contact sensitizer for alopecia areata
Hi All,
Ive had alloecia for about 8 months now, more accutely for about 5 months, Ive been using dermovate for 4 months, and 4 weeks ago went for my first round of steriod shots. Ive had quite extencive regrowth, but new patches still apear, about 35% of my head has been effected.
Had a follow up with a derm (not the one who administered the shots) about two weeks ago, who said because I showed signes of atrophy (dents where the shots had be given, which I understand is quite normal), she would not recomend continuing with steriods.
She wants to try a contact sensitizer (DCP). I understand this works by creating an allergic reaction at the site of the desise - distracting the immune system from attacking the hair.
Just wondering if anyone else here has any experiance of this?
Thanks
Steve
Ive had alloecia for about 8 months now, more accutely for about 5 months, Ive been using dermovate for 4 months, and 4 weeks ago went for my first round of steriod shots. Ive had quite extencive regrowth, but new patches still apear, about 35% of my head has been effected.
Had a follow up with a derm (not the one who administered the shots) about two weeks ago, who said because I showed signes of atrophy (dents where the shots had be given, which I understand is quite normal), she would not recomend continuing with steriods.
She wants to try a contact sensitizer (DCP). I understand this works by creating an allergic reaction at the site of the desise - distracting the immune system from attacking the hair.
Just wondering if anyone else here has any experiance of this?
Thanks
Steve
Replies to This Discussion
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Permalink Reply by Cristian on
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Hi Steve,
I had tried Dermoavate for about 6 months with no visible improvements whatsoever. Not only that i start loosing more hair, but I started to develop a quite sever acne (pimples, blemishes, spots, zits) on the spots that i was applying the cream on the face but also on my scalp. I had been at the doctor and I was advised to stop - it is 2 months now and i still have some annoying pimples full of puss on my face that continuously appear.
Before going for Dermovate i did tried an "Contact Sensitizer" but it was really tough and again with no effects for me. I had to apply a substance on the spots which produced a rush. I did this treatment only for a couple of weeks, less then a month because it is was not only painful, when you apply the substance it simply burns you, but it was also looking very bad - after applying it a couple of times your skin starts to scale off, it turns red and it looks very unhealthy. I had to wear a hat all the time during the treatment.
Hence I wouldn't recommend unless you have no other choice and you really feel trying it on your own skin.
Cheers and good luck,
Cristian
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Permalink Reply by mischa on
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hi steve,
just want to share with you my treatment, i cant give you my opinion about DCP.sorry.
and also, i am new in this site, im quite excited to say something and to read other's opinion and progress of thier treatment.
i have been suffering from alopecia areata about 3 and half years ago..
i have learned that i have alopecia only last year November(first time i seeked medical treatment). I started my treatment on the same month, it was corticosteriod.
i have 2 patches on the side of my head close to the forehead, funny thing is, almost the same size and the same location, i have also big patch at the back of my head(really big, 4 inches wide) , it is a good thing that i still have hairs to cover the patch.
i had 2 iches patch at the center of my head, which now, i could say that i have my hair back on this patch.
Corticosteroids really works as yours..i had an extensive regrowth after 2 shots (november and december)and there is no patches reappear. My doctor didnt ask me to come back for another shot as she told me to be patient until my hair regrows. Since then, i have not seen her or received any treatment from any doctors. its been already a year and i am happy with the results though it is slow. my patches besdie my forehead are covered now with hairs same with the patc at the center of my head. and now cold see progresswith the pacth at the back of my head, as i said it is a bit slow, i understand because it is too large. but there are hairs comming out.
i have also benen taking some vitamins such vit b12. ctually i am taking omibionta (its is for vitamins for the prepartion of pregnancy) it has a lot of vitamins. i think it helps because i had less falling hair..
hey, i i talk to much, hope you'll find the right treatment..thanks.
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Permalink Reply by Amy on
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DCPC is the most effective treatment for AA- with upwards of 90% reponse rate for patchy AA. However, it can lead to blistering and pain and may take 3-12 months for results. You in theory dont need the blisters for it to be effective but it can be hard to control the levels.
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Permalink Reply by BaldGirlsDoLunch.org on
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I'm interested to see if someone has a link to a report that references these stats. I'm wonky about research updates.
I've never spotted a published report advising DCPC for anything other cases of extensive AT or AU.
Curious to know on which continent there's a practitioner applying DCPC to patchy alopecia.
I use these studies below. Even though there's variability in what constitutes " success" and "acceptable regrowth", up to 40% regrowth is pretty standard.
"The allergic response the body makes to the chemical(s) results in good hair regrowth with claims of a 38% success rate for DPCP (Shapiro 1993), 63% for DNCB (Swanson 1981) and up to 70% for SADBE (Flowers 1982). However different investigators report different success rates for the same contact sensitizer. For example, in using SADBE some investigators report only a 50% chance of response (Case 1984, Johansson 1986), or even less (Valsecchi 1986, Caserio 1987). The variability in success rates varies at least in part due to different investigators' different definitions of what constitutes successful regrowth (ie success = light fuzz?, patchy regrowth?, total recovery? etc)." McKelwee, University of Brisith Columbia
Thea
baldgirlsdolunch.org
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Thea, I dont know the exact study I read that had 89% for patchy AA. There are a wide range of studies on contact immunotherapy with a wide range of results. However, it does appear to be the most succesful treatment in a poor lot of options. Here are some pubmed studies and other guidance attached. Over time I have read all 2000+ pub med studies on AA, which I have had for 20 years (now recently AU). And I have also read most immunology, allergery, and foreign medical journals. Unfortunately I dont save all the links or catalog them so if I come across that study again I will think of you and send it along. I do know recalcitrant patchy AA is treated with DPCP though not as a first line treatment. I have read of this in studies and have also talked with people who have done it. My message was not to imply that there is a 90% success rate for patchy AA. But at least one peer reviewed study got that result- eg: "upwards of 90%". The bottom line is its worth a try if you're up for it and desperate. I never did try it. My AA was always hidden until I went AU, and now I am not sure I want to deal with possible whole-head rawness. Anyway, I know people who have had luck with it and others who became allergic or did not respond.
Contact Immunotherapy (Strength of Recommendation B, Quality of Evidence II-ii)
Contact immunotherapy was introduced by Rosenberg and Drake in 1976.[25] The contact allergens that have been used in the treatment of alopecia areata include 1-chloro-2,4-dinitrobenzene (DNCB), squaric acid dibutylester (SADBE) and 2,3-diphenylcyclopropenone (DPCP). DNCB is mutagenic against Salmonella typhimurium in the Ames test[26] and is no longer used. Neither SADBE nor DPCP are mutagenic. One DPCP precursor is mutagenic[27] and batches should be screened for contaminants by the supplier. DPCP is more stable in solution and is usually the agent of choice.
The protocol for contact immunotherapy using DPCP was described by Happle et al. [28] The patient is sensitized using a 2% solution of DPCP applied to a small area of the scalp. Two weeks later the scalp is painted with a weak solution of DPCP, starting at 0.001%, and this is repeated at weekly intervals. The concentration is increased at each treatment until a mild dermatitis reaction is obtained. Some clinicians treat one side of the scalp initially to distinguish between a treatment response and spontaneous recovery if hair regrowth occurs. Once hair regrowth is observed, both sides of the scalp are treated. In patients with severe long-standing alopecia, in whom spontaneous recovery is unusual, this precaution is unnecessary. Opinions are divided on whether patients should be allowed to treat themselves.
Once a maximum response is achieved most practitioners reduce the frequency of treatment. In patients in whom full regrowth of hair is obtained treatment can be discontinued. Subsequent relapses will usually respond to further contact immunotherapy, although this cannot be guaranteed.
A review of all the published studies of contact immunotherapy concluded that 50-60% of patients achieve a worthwhile response but that the range of response rates was very wide (9-87%).[29] Patients with extensive hair loss are less likely to respond.[30,31] Other reported adverse prognostic features include the presence of nail changes, early onset and a positive family history.[29] In most studies treatment has been discontinued after 6 months if no response is obtained. In a large case series from Canada clinically significant regrowth occurred in about 30% of patients after 6 months of treatment but this increased to 78% after 32 months of treatment, suggesting that more prolonged treatment is worthwhile.[32] The response in patients with AT/AU was less favourable at 17% and this was not improved by treatment beyond 9 months. Relapses may occur following or during treatment. In the Canadian series relapse following successful treatment occurred in 62% of patients.
Two case report series of contact immunotherapy in children with alopecia areata reported response rates of 33%[33] and 32%.[34] A third study found a similar short-term response in children with severe alopecia areata, but < 10% experienced sustained benefit.[35]
Adverse effects. Most patients will develop occipital and/or cervical lymphadenopathy during contact immunotherapy. This is usually temporary but may persist throughout the treatment period. Severe dermatitis is the most common adverse event but the risk can be minimized by careful titration of the concentration. Uncommon adverse effects include urticaria,[36] which may be severe,[37] and vitiligo.[38,39] Cosmetically disabling pigmentary complications, both hyper- and hypopigmentation (including vitiligo), may occur if contact immunotherapy is used in patients with racially pigmented skin. Such patients should be warned of this risk before embarking on treatment. Contact immunotherapy has been in use for 20 years and no long-term side-effects have been reported.
Precautions. Contact immunotherapy is an unlicensed treatment that uses a nonpharmaceutical grade agent. Patients should be fully informed about the nature of the treatment; they should be given an information sheet and give signed consent. Great care must be taken to avoid contact with the allergen by handlers, including pharmacy, medical and nursing staff, and other members of the patient's family. Those applying the allergen should wear gloves and aprons. There are no data on the safety of contact immunotherapy during pregnancy and it should not be used in pregnant women nor in women intending to become pregnant. Owing to these concerns about sensitization and the extent of the measures required to prevent this, and also because of the possible risks in pregnancy, availability of contact immunotherapy is limited and many departments are unwilling to provide this treatment.
DPCP is degraded by light. Solutions should be stored in the dark and patients should wear a hat or wig for 24 h following application.
Alopecia areata: topical immunotherapy treatment with diphencyprone.
Avgerinou G, Gregoriou S, Rigopoulos D, Stratigos A, Kalogeromitros D, Katsambas A.
1st Academic Department of Dermatology, University of Athens Medical School, A Sygros Hospital, Athens, Greece.
BACKGROUND Topical immunotherapy with diphencyprone (DPCP) is considered the most effective treatment of alopecia areata (AA). OBJECTIVE: To assess the efficacy of DPCP in the treatment of extensive or long-lasting AA in Greek patients. METHODS: Sixty-four patients with extensive and/or long-lasting AA were sensitized with 2% diphencyprone. During each weekly subsequent visit, patients were treated with gradually denser concentrations adjusted in order to maintain erythema and itch on the patient's scalp for 48 h. Patients' hair re-growth was evaluated every 3 months for 2 years. RESULTS: Forty-five patients responded among the 54 completing therapy (83.3%). Initial response was observed 3.48 +/- 1.05 months after the initial treatment. Twenty patients among the responders achieved a grade 4 response, 15 patients achieved grade 3, 9 patients achieved grade 2, and 1 patient achieved a grade 1 response. The mean duration of treatment until maximum response was 6.14 +/- 1.48 months. Thirty-one patients (68.9%) had a relapse during follow-up and were treated again. The only adverse event among patients completing therapy was contact dermatitis of the face or neck (9 of 54) that resolved after topical corticosteroid application within 7 days. Statistical analysis did not establish any association among duration of AA, age, gender, atopic diathesis, nail involvement and presence of thyroid antibodies with response to treatment. CONCLUSION: Treatment of Greek patients with AA with diphencyprone presents high response rates similar to those reported by previous studies. The treatment is adequately tolerated by most of the patients, and they are willing to repeat it in cases of relapse.
Topical immunotherapy of severe alopecia areata with diphenylcyclopropenone (DPCP): experience in an Iranian population.
Aghaei S.
Department of Dermatology, Jahrom Medical School, Jahrom, Iran. shahinaghaei@yahoo.com
BACKGROUND: Highly variable results of topical diphenylcyclopropenone (DPCP) in the treatment of alopecia areata have been reported so far. The purposes of the present study were to evaluate the efficacy and tolerability of DPCP treatment in severe alopecia areata. METHODS: Twenty-eight patients (16 female and 12 male, 10-35 years old, mean age 25 years) with extensive alopecia areata were enrolled in an open-label clinical trial. After sensitization with 2% DPCP, progressively higher concentrations beginning at 0.001% were applied weekly for 6 months to one side of the scalp, after which, if terminal hair growth was noted, the entire scalp was then treated under the same weekly protocol. The maximum concentration of DPCP in acetone was 2%. RESULTS: Twenty-seven of 28 patients completed therapy. The overall response rate was 81.5% (22/27), complete remission (90%-100% terminal hair re-growth) was obtained 22.2% (6/27) and partial remission (10%-90% terminal hair re-growth) in 59.3% (16/27). In all patients an eczematous reaction consisting of erythema, itching, and scaling at the site of application were observed. During therapy, other side effects including, occipital lymphadenopathy 40.7% (11/27), severe eczema/blister formation 40.7% (11/27), hyperpigmentation 18.5% (5/27) were observed, but no hypopigmentation, vitiligo, contact urticaria, and erythema multiforme-like reaction were seen in the patients. Nineteen of 27 (70.4%) patients had at least one side effect, other than eczematous reaction. Notably, partial recurrence was observed in 50.9% (13/22) of these patients after 6 to 12 months of follow-up. During the follow-up time the maintenance DPCP immunotherapy was continued. CONCLUSION: Topical DPCP treatment for alopecia areata is an effective therapy with a slightly high relapse rate during bilateral maintenance treatment. According to the author's knowledge this is the first experience with DPCP in Iran.
PMID: 15918897 [PubMed - indexed for MEDLINE]
Diphenylcyclopropenone (diphencyprone, DPCP) in the treatment of chronic severe alopecia areata (AA).
Galadari I, Rubaie S, Alkaabi J, Galadari H.
Faculty of Medicine and Health Sciences, UAE University, Dermatology Department, Al-Ain Hospital, Al-Ain, UAE.
BACKGROUND: Diphenylcyclopropenone (DPCP) has been reported to be an effective topical immunotherapy of extensive alopecia areata (AA) with highly variable reported results. OBJECTIVE: The purposes of this study were to assess the efficacy, side effects, and adverse prognostic factors in the treatment of alopecia areata with DPCP. METHODS: 21 patients were included in the study with chronic and extensive AA. Patients were sensitized in the beginning with 2% DPCP, and the concentrations were increased gradually beginning with 0.000001% every one to two weeks for a period of 6 months. RESULTS: 15 patients (71.4%) had a complete or partial recovery at the end of the treatment period. Most frequent side effects were erythema at the site of application, pigmentation, and lymph node enlargement. The most important adverse prognostic factors were duration of AA, history of atopy, and presence of nail changes. CONCLUSION: Treatment of AA with topical DPCP is effective. Though the treatment may have some side effects, in most cases they are tolerable and respond well to treatment.
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Hi Amy,
I try to follow research and treatments for AA in published journals as much as I can. I consult with an academic and clinical dermatologist in NY who follows the literature, too. I've never seen anything noting a response rate even close to 90%. It usually hovers around %40 from the published reports of the person who I believe has the most clinical experience of anyone ( thousands of cases) - Jerry Shapiro, MD from the University of British Columbia.
Maybe it's a typo? or you've found another article . Please share the source of the info if you can locate it.
Thanks,
Thea
baldgirlsdolunch.org
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Hi,
Is this the same Jerry Shapiro that started the research company TrichoScience? (http://www.trichoscience.com/)
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Hi Steve,
I was told in the UK that DCP can produce results within 3 months, so looking into it when I came to Brisbane. Unfortunately the derm I saw really didn't seem to know much ... he 'had read' about it and ended up sourcing me a bottle of 0.01% to try myself at home. I did so a few days ago and my head is now covered in horrible boils / puss etc. I've since checked out on the Intranet and derms are supposed to do a sensitizing test first, then gradually increase your strength. Also, apparently, if bottles are more than 3 months old, the acetone can evaporate making it stronger ... hope it works for you, but can lead to some pain if it's not administered right. Although sounds like your derm knows more about what she's talking about.
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Oh I hope you recover ok......so sorry to hear that happened. You might want to show the doctor or at least tell him what happened so he doesn't advise someone else do the same thing. If you can't see the back of your head, be sure it's getting cleared up and not getting infected. Ask what you need to do to help it heal the best.
It's very strong stuff. Now the protocols recommend a lower strength, but years ago it was believed that creating a controlled blistering response was needed to stimulate hair growth.
One of the disadvantages of the treatment often written about is the inconvenience in that it requires( for patient safety) going to the medical office to have it applied.
Thea
baldgirlsdolunch.org
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Permalink Reply by Steve on
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Hi Helen,
Thanks for your respence, and I'm sorry to hear you had such a hard time with this - there really are no easy answeres when it comes to alopecia treatment it seems. I've had the sensitization now, which I had no reaction to at all! I think I'll give it a wirl and see how it pans out. If I end up with blisteres I'll certainly give it a wide bith as I think I'd rather just live with the alopecia!
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Good luck Steve, will keep my fingers crossed for you!
Thanks Thea - it's all cleared up now & have decided I'd rather live with no hair than pain for the moment. Although am sure I'll try something else that sounds good at some stage ...
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Permalink Reply by Jaime Murphy on
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Good luck with your treatment steve...just reading about DCP gives me shivers lol. I had a really bad experience with it while I was in high school, pretty much turned my entire scalp into puss blisters. I couldn't sleep, shower, or wear anything other than a loose bucket hat on my head. I'd rather stick with my bald head than go through something like that again! Hopefully your dermatoligist is better than mine was!
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