Topical Sensitizers in Alopecia Areata

Amy J. McMichael; Robert L. Henderson, Jr.

Disclosures

Dermatology Nursing. 2004;16(4) 

In This Article

Patient Selection

The best candidates for topical sensitizer treatment include those with severe cases of AA, such as having greater than 50% total scalp involvement with large patches or alopecia totalis. The treatment avoids injections, which is particularly attractive when treating children, offers an alternative to corticosteroids, and offers additional hope after several other standard treatments have failed. Clinical judgment must be exercised for each case since the treatment may be too irritating in patients with atopic dermatitis or those who have easily irritated skin. In patients with little reaction to allergens, sensitizers may not work at all. In patients with small areas of AA involvement, sensitizers may be too difficult to apply through the surrounding hair and are usually unsatisfactory for those who desire fast results. Treatment will also require patients who can followup regularly and can follow complex instructions for self-application (if self-treatment is recommended).

Overall, topical sensitizers are well-tolerated and not time consuming. It is best to not begin treatment prior to an important social event in case a fulminant dermatitis results. Topical corticosteroids and oral antihistamines can be used should such a reaction ensue. It is best to supply samples or a prescription of such treatments when beginning so the patient can be prepared for a severe dermatitis.

Thorough patient education should be addressed and will only increase appropriate compliance and treatment response. Providing a patient handout describing what the medication is and what to expect is beneficial. Since no topical sensitizer is FDA approved, this fact should be openly discussed in the beginning of treatment.

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