Topical immunotherapy in combination with anthralin in the treatment of refractory alopecia areata.
BACKGROUND
Treatment is often challenging in patients with alopecia areata. We often try topical immunotherapy to treat alopecia areata in Japan. Anthralin is sometimes used in other countries.


OBJECTIVES
The aim of this study was to examine effectiveness of combination therapy with both topical immunotherapy with squaric acid dibutylester or diphenylcyclopropenone and anthralin in the treatment of refractory alopecia areata.


METHODS
We treat four patients with refractory alopecia areata by topical immunotherapy and anthralin. Two patients had alopecia areata multilocularis and the other two patients had alopecia totalis. The entire scalp was treated with weekly application of squaric acid dibutylester or diphenylcyclopropenone and daily 0.5% anthralin ointment. Patients were followed up weekly, and adverse effects were recorded.


RESULTS
One patient with multifocal patches of alopecia areata got complete hair regrowth at week 30, the other patient with multifocal patches of alopecia areata turned for the worse at week 30 and recovered at week 52. Hair regrowth was not seen in the other two patients with alopecia totalis. Localized pruritis and hyperpigmentation of the scalp were seen in two patients.


CONCLUSIONS
To treat alopecia areata unresponsive to topical immunotherapy alone, topical immunotherapy in combination with anthralin is worth a try.
['Kagami|Shinji|S|https://orcid.org/0000-0002-9857-6555', 'Kishi|Yuriko|Y|', 'Hino|Haruko|H|']
D000287:Administration, Topical D000506:Alopecia Areata D000875:Anthralin D006801:Humans D007167:Immunotherapy D007564:Japan D016896:Treatment Outcome
DPCP SADBE contact immunotherapy intractable alopecia recalcitrant alopecia