Diphenylcyclopropenone in severe alopecia areata in children and adolescents: long-term follow-up and relapse rate

BackgroundReports on the long-term treatment of alopecia areata (AA) in children with diphenylcyclopropenone (DPCP) are few.ObjectiveTo assess response, side effects, and relapse rates during long-term follow-up in children with severe AA treated with DPCP. Effect of different patient and treatment-related factors on prognosis and value of maintenance therapy were also assessed.Patients and methodsIn this interventional prospective study, 144 patients of AA were treated with DPCP. Response was assessed according to sex, type of AA, age of onset, and duration of disease. Excellent response was defined as terminal hair covering more than 75% of the scalp. Maintenance therapy meant ongoing therapy once every 2-4 weeks after excellent response. Follow up for an average of 22 months was performed to detect any relapse of AA which meant more than 25% hair loss.ResultsNinety-two patients completed 12 months of therapy. Thirty (32.6%) patients achieved excellent response, 33 (35.9%) moderate, and 29 (31.5%) poor response. Seventy-three patients completed 18 months of therapy. Fouty-eight (65.8%) achieved excellent response, 10 (13.7%) moderate, and 15 (20.5%) poor response. Different clinical variables did not affect the response, however, a significant difference in the beginning of terminal hair growth according to type of AA was found (P=0.002) where 10% of responders among alopecia universalis patients started to grow terminal hair more than 12 months after the onset of therapy. Side effects were few and tolerable. Relapse occurred in 47% of patients on maintenance and 78% of patients without maintenance therapy (P=0.048).ConclusionDPCP is an effective and safe treatment of severe AA in children. Prolonging the duration of therapy may improve the response in alopecia universalis and alopecia totalis. Maintenance therapy is recommended to reduce the risk of relapse.