DPCP Immunotherapy Yields 61.8% Hair Regrowth Rate in Pediatric Alopecia Areata

Treatment with topical immunotherapy diphenylcyclopropenone (DPCP) yielded an 8.8% complete response rate and a regrowth rate of 61.8% for any regrowth of hair in pediatric patients with alopecia areata (AA), according to a study published in Skin Health and Disease.¹

Researchers also found that baseline disease severity may have impacted the overall treatment efficacy.

Image Credit: © DermNet

Background and Methods

DPCP's efficacy has been demonstrated in hair loss in several previous studies. When used alone, it has demonstrated efficacy in AA.² When utilized in combination with platelet-rich plasma in cases of severe or recalcitrant AA, researchers reported a 54.5% regrowth scale rate in patients treated with both therapies. Additionally, they reported a comparable regrowth scale rate of 53.85% in patients treated with DPCP alone.³

Researchers conducted the present retrospective, single-center study from March 2016 to March 2021 at a dermatology hospital focused on pediatric patients with AA treated with DPCP.

Findings

The cohort of 97 patients had a slight male predominance, with 53.6% of the patients being male. The average age of participants was 11.1 years, with the majority (43.3%) falling within the 6 to 12 years age group. Prior treatments predominantly included topical steroids (58.1%) and minoxidil (27.4%).

At 6 months of treatment, results demonstrated that 51.5% of patients had no response to the treatment. Researchers observed a minimal response in 30.9% of patients, with 14.4% exhibiting partial response, and 3.1% achieving complete response.

By the 12-month follow-up, 38.2% of patients demonstrated no response, 26.5% showed minimal response, another 26.5% had partial response, and 8.8% achieved complete response.

Researchers also identified several key factors influencing treatment outcomes, including type of alopecia, duration of disease, duration of treatment, and baseline severity.

At 6 months, patients with patchy alopecia responded more favorably compared to those with other types, with statistical significance observed. Researchers also found that a longer disease duration of AA was associated with poorer treatment response at 6 months, then diminishing by 12 months.

Furthermore, duration of treatment with DPCP was a significant predictor of treatment response. Patients with a longer treatment duration had better outcomes both at 6 months (15.4 months vs. 12.1 months) and at 12 months (19.4 months vs. 13.2 months).

The Severity of Alopecia Tool (SALT) score at the start of treatment was inversely related to treatment response. A higher initial SALT score, indicating more severe AA, was associated with a lower probability of achieving a positive treatment outcome.

After 6 months, 53.6% of patients reported no complications. The most common adverse effects were blisters and vesicles, occurring in 38.1% of cases. By the 12-month follow-up, 55.9% of patients had experienced complications, with blisters and vesicles remaining the most frequently-reported issues.

Conclusions

Researchers noted that findings align with past research into DPCP's role in AA management. It also highlights the importance of early disease severity measures and treatment adherence, for example. Study authors recommended long-term studies of a longitudinal nature that compare DPCP's treatment versus other modalities.

The study may have been limited by selection bias, a limited sample size, and the study's single-center nature.

"Our findings advocate for a more integrated role of DPCP in the management of paediatric AA, aligning with current clinical guidelines that typically reserve DPCP as a secondary treatment," according to Esmaeili et al. "The results underscore the need for personalized treatment approaches and continuous patient engagement to optimize therapeutic success."

References

1. Esmaeili F, Vahabi SM, Abdoli M, et al. Topical immunotherapy with diphenylcyclopropenone in paediatric patients with alopecia areata—a retrospective study of 97 patients. Skin Health Disease. August 19, 2024. https://doi.org/10.1002/ski2.441
2. JP Cardia, PA Pavco, WR Levis. Diphencyprone treatment of alopecia areata: postulated mechanism of action and prospects for therapeutic synergy with RNA interference. Journal of Investigative Dermatology symposium proceedings. Elsevier; 2015.
3. Abd El-Magid WM, Mohamed RAE, Elsharkawy REE. Diphenylcyclopropenone and platelet-rich plasma in the management of severe or recalcitrant alopecia areata. J Cosmet Dermatol. 2023; 22(11): 2971–2981.