Alopecia Areata
Diphenylcyclopropenone (DPCP) also known as Diphencyprone has been employed for decades for the treatment of Alopecia Areata. Hapten Pharmaceuticals Samcyprone™ is a GMP produced proprietary DPCP gel that is available in 0.4% and 0.04% concentrations.
Alopecia Areata (AA) is thought to be caused by the loss of the Immune Privilege (IP) of hair follicles. Gulati Et al. have demonstrated that the resolution phase of the DTH IV reaction caused by DPCP dramatically increases immunosuppressive factors at the application site. This immunosuppressive microenvironment persists for approximately 14 days after application before returning to baseline.
Biweekly application of Samcyprone™ can restore IP to the hair follicle microenvironment. The restoration process can take up to 6 months of treatments with monthly maintenance treatments possibly required thereafter. Unlike JAK inhibitors, Samcyprone™ treatment is not systematic and avoids the possible immunosuppressive side effects of JAK therapy.
JAAD Game Changer: ‘‘Subclinical sensitization with diphenylcyclopropenone is sufficient for the treatment of alopecia areata: Retrospective analysis of 159 cases’’. Adam J. Friedman, MD. J AM ACAD DERMATOL VOLUME 89, NUMBER 6
Given the limited armament available for alopecia areata and more importantly, totalis and universalis, identifying means to improve utilization of what is available is of the utmost important.
In this study, investigators found that there is no clinically relevant correlation between the once hoped for adverse events with contact immunotherapy and clinical outcomes.
Visual and histologic evaluations demonstrated that subclinical sensitization and fewer diphenylcyclopropenone treatments could
elicit the required response to produce a clinically meaningful outcome.
Long-term prognosis of subclinical sensitization with diphenylcyclopropenone in patients with alopecia areata
Sang-Hoon Lee , Yeon Woo Heo , Won-Soo Lee. J Am Acad Dermatol. 2023 Apr;88(4):912-914
To the Editor: Contact immunotherapy is widely usedin the treatment of severe alopecia areata (AA). However, due to varied treatment response to contact immunotherapy, predicting the prognosis of AA is challenging. A systematic review of contact
immunotherapy reported a recurrence rate of 49% in the absence of maintenance treatment. However, there were no results for long-term prognosis. The modified diphenylcyclopropenone (DPCP) treatment protocol, characterized by subclinical sensitization, has a therapeutic efficacy as favorable as that of the standard protocol, with fewer side effects. In a previous study conducted at our institution in 2017, 46 of 159 patients who underwent the modified DPCP treatment protocol showed complete response (CR). After a 2-year follow-up of patientswho achieved CR during that time, 20 experience recurrence. The purpose of this study was to
examine the long-term prognosis and related factors by confirming the recurrence of AA in the remaining 26 patients with CR.
Subclinical sensitization with diphenylcyclopropenone is sufficient for the treatment of alopecia areata:
Retrospective analysis of 159 cases
Sung Jay Choe, MD, Solam Lee, MD, Long Quan Pi, PhD, Dong In Keum, MD, Chung Hyeok Lee, MD, Beom Jun Kim, MD, and Won-Soo Lee, MD, PhD. J Am Acad Dermatol. 2018 Mar;78(3):515-521
Abstract
Background: Contact immunotherapy with diphenylcyclopropenone (DPCP) is presently considered the treatment of choice for extensive alopecia areata. However, a major concern with contact immunotherapy is that it causes various adverse effects (AEs) that contribute to discontinuation of treatment.
Objective: We investigated whether a modified DPCP treatment protocol can promote hair regrowth with fewer AEs.
Methods: All patients were sensitized with 0.1% DPCP and began treatment with 0.01% DPCP. Thereafter, the DPCP concentration was slowly increased according to the treatment response and AEs. This was a retrospective review of DPCP treatment with modified protocols in 159 patients with alopecia areata.
Results: Of the 159 patients, 46 (28.9%) showed a complete response and 59 (37.1%) showed a partial response. No patients had AEs after sensitization. During the treatment, only 3 patients (1.9%) showed severe AEs, and 55 showed moderate AEs; however, all were well controlled with antihistamines alone or antihistamines and medium-potency topical steroids. There was no association between treatment response and AEs.
Conclusion: A modified DPCP treatment protocol with subclinical sensitization could induce a favorable therapeutic response and result in fewer AEs.
