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Squaric acid treatments
I am looking for some opinions and insite...
A new Derm that I went to see this week at Hershey Medical center here in PA who is a Scalp and skin specialist has suggested I try squaric acid treatment.
Has anyone used this treatment and what is your opinion or outcome? I know everyone reacts differently but just trying to see if this is something I want to try.
Thanks
Replies to This Discussion
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Permalink Reply by chris for hair on
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Did some research, and squaric acid is a skin irritant. In some people it does SEEM to help with growth, but the consciences is that many cases of Alopecia resolve on their own so there is no definitive evidence that the squaric acid actually made the hair return.
From Medscape:
9·2·3 Contact Immunotherapy (Level of Evidence 2++) Contact immunotherapy was introduced by Rosenberg and Drake in 1976.[41] 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 fell from favour when it was found to be mutagenic against Salmonella typhimurium in the Ames test.[42] Neither SADBE nor DPCP are mutagenic. One DPCP precursor is mutagenic,[43] 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. [44] 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 longstanding alopecia, where 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 where 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 the range of response rates was very wide (9–87%).[45] Patients with extensive hair loss are less likely to respond.[46,47] Other reported adverse prognostic features include the presence of nail changes, early onset and a positive family history.[45] 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.[48] 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%[49] and 32%.[50] A third study found a similar short-term response in children with severe alopecia areata but < 10% experienced sustained benefit.[51]
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 effect but the risk can be minimized by careful titration of the concentration. Uncommon adverse effects include urticaria,[52] which may be severe[53] and vitiligo.[54,55] Cosmetically disabling pigmentary complications, both hyper- and hypopigmentation (including vitiligo), may occur if contact immunotherapy is used in patients with pigmented skin. Such patients should be warned of this risk before embarking on treatment. Contact immunotherapy has been in use for 30 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 (i) be fully informed about the nature of the treatment; (ii) be given an information sheet; and (iii) 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.
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.
So, if you choose to try this, be sure your compounder is sterile, and do not allow sun to contact the area treated.
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Permalink Reply by Dorothy G. on
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I tried it for about a month or so and it didn't do anything. I didn't have any bad reactions.
I have decided after a few years and lots of shots, not to do any treatment.
I found it a lot easier.
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Permalink Reply by Carmen on
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Hey everyone! I too have been recommended this treatment by my dermatologist. I know the results will differ but I was wondering if anyone knew about the side effects. When I first heard about it, it sounded pretty scary to me and I didn't find much information from google. My doctor is part of a hospital and she said the hospital used to do the treatment but has discontinued it which makes me even more nervous. My hair has amazingly all grown back however, it still continues to fall out daily and I think I am having the beginnings of another bald spot (to which I am trying to not freak out too much about.) Any info would be great, thanks!
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We just started this for my 9 year old daughter. 3 weeks...not seeing anything. Saw better results with the injections. Although, since she is completely bald, you can see exactly where each shot was because those are the exact spots where there is a bit of peach fuzz. Doctor doesn't feel that we can continue shots for the rest of her life so we decided to try the acid. Might go back to shots again since the results are better. I am open for any suggestions at this point. Someone told me about ultraviolet light therapy...does anyone know anything about that?
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Hi Nikki's Mum. Karen here. Your blog brought up two 'solutions' which were recommended to me and initially worked short term but were then discarded by me due to their potential long term dangers. Cortisone injections are notorious because, once it enters the body it's there for good which is why continued shots aren't recommended for long term use. My T cell soldiers were also extremely good at their job and began to jump over the areas given the shots to continue their dedicated quest to get rid of my hair. The six months of ultraviolet light therapy was not successful utilising , I hypothesise, the same idea as the squaric acid.... to irritate the skin to promote a reaction. In my opinion and from my personal experience, I am so sorry to say, they are both band aid solutions with dangerous side affects and are not worth the prolonged grief.
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Hi Karen,
I have frontal fibrosing and I am looking at a narrow band fiber optic UVB brush that delivers the light directly to the scalp. Do you have a scarring alopecia? This medical device is expensive and the rationale is that the hair does not block any of the light giving it a better chance for success. Was your ultraviolet narrow band UVB or UVA? What delivery system was used? Any info is greatly appreciated. My hair is going fast.
Nancy79
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Hi Becca74. I have tried squaric acid and DPCP. They both worked for me but I am doing squaric acid at the moment because my first derm ended up going on a leave of absence.
In my intial sensitatzation the nurse applied 2% acid on the left side of my head and I had complete, full and thick regrowth within about 2 months. (I normally have thick hair). The area was red and itchy. A couple of weeks later, the nurse applied it in a lower dosage, i believe 0.1%, on some more areas of my head. I had an extremely itchy reaction where my scalp was red, raised skin from itching and eventually turned into blisters. I advise to take bendedryl during this time. At the time I was in NYC (I live in San Francisco) so the situation was even worse because of the heat when wearing a wig. Remember, these reactions are good because it means it is working. Just tell yourself this and it will make you feel better about the blisters! After, I have started applying the acid and just get itchy but have not really gotten blisters. I have grown back 80% of my hair but the sides have been difficult to grow, but I am getting peach fuzz on the sides, slowly but surely. Would I recommend trying the treatment? Yes, I would. Good luck!
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Permalink Reply by Becca74 on
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Amy, thank you. I am a little concerned as my derm only did about a quarter size spot on my head of the 2% and no reaction..Then went back 2 weeks later which was just 2 weeks ago and they put 5 spots on my head of different dosages from 2% to .001% I believe and I am really seeing no reaction in any of the spots so not sure what to do.
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Hi there , I started this resume to 3 mos ago. First he it was a couple patches he did every 2 weeks. Then he decided to do the whole head at once. I had a terrible reaction. Blisters , itchiness , and pain. But 3 week after this I started hair growth. Alot of hair growth. I have AU. BET SEVERE CASE OF IT . But for me it's worth the pain , because I want my hair back . They will switch strengths of Swarovski acid . But stay strong and positive.
Also I would like to add. I became gluten and dairy free , I think this has a link to auto immune disorders.
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I have had this and I believe it is what actually sent me into a spiral of loosing all my hair. It started out as small patches of hair falling out and I went to a derm and he made me a batch of the Squaric acid. AS soon as I took it my skin swelled at the spots I treated with pus and fluid draining from the spots that I treated. It itched so bad I almost lost my mind. About a month after using the treatment of the acid is when all my hair fell out. I have had no hair now for 9 years. I'm not saying not to try it but this is just what had happened to me after using it.
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