Topical Sensitizers in Alopecia Areata

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

Disclosures

Dermatology Nursing. 2004;16(4) 

In This Article

Efficacy

Controlled studies demonstrating conclusive efficacy of all the sensitizers in alopecia areata are lacking. A retrospective chart review in our clinics from 1996 through 1999 demonstrated a 33% cosmetically acceptable or total regrowth in responders to SADBE (Pardasani, Turner, & McMichael, 2001). Micali et al. (1996) demonstrated an 80% rate of regrowth in less-severe forms and 49% in more severe cases with SADBE. DNCB was significantly effective in a group of 90 patients with alopecia areata (Happle, Cebulla, & Echternacht-Happle, 1978), with 80 (89%) regrowing hair exclusively or thicker on the treated side and 72 (80%) having persistent responses. Other reports have shown similar efficacy for all the sensitizers.

Despite an appropriate selection of good candidates, topical sensitization proves ineffective in some cases. A reported 1% to 2% of patients cannot be sensitized (Van der Steen & Happle, 1993), and successful sensitization can be lost. Tolerance is reported in 10.8%, though concomitant oral cimetidine may avert the loss (Daman & Rosenberg, 1977).

Negative prognostic factors for response to topical sensitization include duration and extent of disease, younger age of onset, family history of alopecia areata, and nail changes evident on clinical exam (Iijima & Osuka, 1997; Van der Steen, Van Baar, Happle, Boezeman, & Perret, 1991; Weise, Kretzschmar, John, & Hamm, 1996). However, an early development of dermatitis to the agent is viewed as a positive sign in all cases.

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