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Background Treatment is often challenging in patients with alopecia areata. We often try topical immunotherapy to treat alopecia areata in Japan. Anthralin is sometimes used in other countries. Objectives The aim of this study was to examine effectiveness of combination therapy with both topical immunotherapy with squaric acid dibutylester or diphenylcyclopropenone and anthralin in the treatment of refractory alopecia areata. Methods We treat four patients with refractory alopecia areata by topical immunotherapy and anthralin. Two patients had alopecia areata multilocularis and the other two patients had alopecia totalis. The entire scalp was treated with weekly application of squaric acid dibutylester or diphenylcyclopropenone and daily 0.5% anthralin ointment. Patients were followed up weekly, and adverse effects were recorded. Results One patient with multifocal patches of alopecia areata got complete hair regrowth at week 30, the other patient with multifocal patches of alopecia areata turned for the worse at week 30 and recovered at week 52. Hair regrowth was not seen in the other two patients with alopecia totalis. Localized pruritis and hyperpigmentation of the scalp were seen in two patients. Conclusions To treat alopecia areata unresponsive to topical immunotherapy alone, topical immunotherapy in combination with anthralin is worth a try.

Background Among alopecia areata (AA) treatments, contact irritants (anthralin) and topical immunotherapies (diphenylcyclopropenone) have been successfully used. Chemoexfoliation can potentially be utilized, acting as irritants and consecutively immunomodulators. Peels via therapeutic wounding provoke growth factors and cytokines that may induce hair regrowth. Aim To evaluate and compare trichloroacetic acid (TCA) 35% and phenol 88% peels effectiveness and tolerability in patchy AA. Patients/methods This comparative, randomized, double-blind study included 20 patients with multifocal patchy AA. In each patient, 2 patches were selected and randomized into group I (20 patches: TCA 35%) and group II (20 patches: phenol 88%). A session was performed every 3 weeks for 9 weeks. Response was assessed by two blinded observers as regards percentage of clinical improvement, severity of alopecia tool (SALT), and trichoscopic scaled scores for dystrophic and terminal hairs, respectively. Patients were scheduled for follow-up visits over 6 months past treatment cessation. Results A total of 19 patients completed the study and showed significant reduction in SALT score. TCA- and phenol-treated patches demonstrated significant improvement in the percentage of clinical improvement, trichoscopic scale of dystrophic and terminal hairs. However, TCA was superior to phenol as it showed significant more reduction in trichoscopic score of dystrophic hairs and significant higher increase in terminal hairs. Phenol yielded significant higher discomfort than TCA. No relapse was detected. Conclusions Trichloroacetic acid 35% and phenol 88% peels can be considered effective therapeutic modalities for patchy AA. TCA 35% represents a treatment of choice in terms of the efficacy and tolerability.

Alopecia areata is a type of non-scarring hair loss. The dysregulation of numerous systemic Th1 (IL-2, IFN-γ, TNF, IL-12, and IL-18), Th2 (IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-17E, IL-31 and IL-33) and Th17 (IL-17, IL-17F, IL-21, IL-22, IL-23 and TGF-β) cytokines was observed in patients with alopecia areata. Positive correlations between the severity of alopecia areata and an increased serum level of various cytokines including IL-2, TNF, IL-12, IL-17, and IL-17E were reported in the literature. An increased serum level of numerous cytokines, such as IL-2, IL-6, TNF, IL-12, IL-17E, and IL-22, was described as positively correlated with the duration of the disease. Moreover, it was shown that increased pre-treatment serum level of IL-12 was a positive, while increased serum levels of IL-4 and IL-13 were negative prognostic markers for the efficacy of diphenylcyclopropenone. In conclusion, alopecia areata is associated with the dysregulation of systemic Th1, Th2 and Th17 cytokines with their role in the pathogenesis, clinical manifestations and prognosis of the disease. Available data indicate the most significant role of serum IL-2, TNF, IL-12, IL-17, and IL-17E as markers of disease activity. The serum levels IL-4, IL-12 and IL-13 may be useful as potential predictors of diphenylcyclopropenone efficacy.

Background Alopecia areata (AA) is a chronic disorder and the best treatment regimen for it is unknown. Currently, one of the best documented treatment modalities for AA is topical immunotherapy. Aim To evaluate the safety and efficacy of a novel method (multi-concentration patch test) versus standard protocol for topical immunotherapy. Methods A prospective randomized clinical trial was conducted on 30 patients with Alopecia areata, half of them received DPCP with a novel method using multi-concentration patch test to determine the optimal initiating concentration of DPCP (case group) and the other half experienced immunotherapy according to the standard protocol (control group). Percentage of hair regrowth after 6 months of treatment and the incidence of drug-related adverse effects were evaluated and compared between the two groups. (IRCT registration code: IRCT20141209020250N5). Results Absolute and relative hair regrowth percentages were reported 25% and 41.49% in case group and 8.2% and 14.21% in control group respectively. Considerable response (more than 75% hair regrowth) was observed in 4 (26.6%) patients in case and 1 (6.6%) patient in control group. The clinical response was initiated about 7 weeks sooner in case compared to the control group (14 versus 7.38 weeks, P: 0.001). Overall, clinical response was higher in patients received new protocol, compared to control group. Moreover, patients who experienced new protocol had a higher level of treatment satisfaction in comparison with patients having standard protocol (P: 0.012). Conclusion This study revealed the effectiveness and safety of the novel multi-concentration patch test DPCP therapy for AA and its priority to conventional method, at least in terms of shortened duration of DPCP immunotherapy.

Anogenital warts are caused by human papillomavirus types 6 and 11. They are rare in children, and treatment is difficult since conventional treatments are generally painful and require the patient to be anesthetized. Topical diphenylcyclopropenone (DPCP) is a contact immunotherapy used for treatments of recalcitrant warts and alopecia areata. We herein report 3 cases of anogenital warts in children successfully treated with topical DPCP. Our results suggest that topical DPCP may be a valuable option for the treatment of anogenital warts in children who have difficulty with painful destructive therapy.

Background and objectives In-transit melanoma (ITM) metastases present a therapeutic challenge and management decisions can be difficult. There are multiple treatments available, with differing efficacy, and supported by different levels of evidence. The primary objective was to perform a systematic review and where suitable, a meta-analysis of the literature reporting on the use of locoregional treatments for the management of ITM. Methods An independent review was conducted including a comprehensive search of the National Library of Medicine using PubMed, MEDLINE, Embase, and Cochrane Library databases. Key data were tabulated, synthesized and pooled to calculate relevant weighted effect sizes for each therapy using random-effect models. The statistical heterogeneity was calculated using the Higgins' method. Results Of the initial 32 612 articles identified, 57 original articles satisfied eligibility criteria. Eight treatment modalities were identified comprising: amputation (7); hyperthermic isolated limb perfusion (15); isolated limb infusion (8); carbon dioxide laser (9); PV-10 intralesional therapy (5); IL-2 intralesional therapy (8); imiquimod (7); diphenylcyclopropenone (3). Only amputation and topical imiquimod were suitable for formal meta-analysis. Conclusions All of the assessed therapies have significant selection bias. Variable levels of evidence support the ongoing use of locoregional treatments and these may significantly improve disease-free survival.

Background Alopecia areata (AA) is a chronic autoimmune disorder. Finding the best treatment regimen for it remains a challenge. Currently, one of the best documented treatment modalities for AA is topical immunotherapy. Aim To evaluate the safety and efficacy of combined DPCP and anthralin versus standard protocol (DPCP alone). Methods A prospective randomized clinical trial was conducted on 50 patients with Alopecia areata who received DPCP alone (group D) or in combination with anthralin (group D/A). Percentage of hair regrowth after 6 months of treatment and the incidence of drug-related adverse effects were evaluated and compared between the two groups. Results Complete hair regrowth was observed among three patients in each group (18.75% in Group D and 15.79% in Group D/A) after 6 months. Moreover, 25% and 31% of patients in group D and 21% and 47% of patients in group D/A had > 75% and > 50% hair regrowth respectively at the end of the study (P-value: 0.696). In addition, earlier age of onset, chronicity of lesions, nail involvement, facial hair loss and extensive lesions at baseline were associated with poor clinical outcome. Conclusion DPCP and anthralin was as effective as DPCP alone and anthralin did not add to the effect of DPCP in treating AA.

The high incidence of patients with chronic itch highlights the importance of fundamental research. Recent advances in the interface of gut microbiota have shed new light into exploring this phenomenon. However, it is unknown whether gut microbiota plays a role in chronic itch in rodents with or without cognitive dysfunction. In this study, the role of gut microbiota in diphenylcyclopropenone (DCP)-evoked chronic itch was investigated in mice and hierarchical cluster analysis of novel object recognition test (ORT) results were used to classify DCP-evoked itch model in mice with or without cognitive dysfunction (CD)-like phenotype and 16S ribosomal RNA (rRNA) gene sequencing was used to compare gut bacterial composition between CD (Susceptible) and Non-CD phenotypes (Unsusceptible) in chronic itch mice. Results showed that the microbiota composition was significantly altered by DCP-evoked chronic itch and chronic itch induced novel object recognition-related CD. However, abnormal gut microbiota composition induced by chronic itch may not be correlated with novel object recognition-related CD.

Alopecia areata (AA) is a common cause of nonscarring hair loss. Diphenylcyclopropenone (DPCP) is a form of contact immunotherapy used in the treatment of AA. We retrospectively reviewed all patients who were diagnosed with AA over a 4-year period (1st January 2012 to 31st December 2015) and who have received DPCP. Forty patients were studied in total. The mean duration of disease prior to the study was 195 days. Patients received a mean number of 14.91 sessions (range: 1-65). The mean number of sessions required before clinical response was seen was 2.33 sessions, corresponding to 0.001% DPCP. Based on the modified Global Assessment Grading System, 33.5% (n = 11) of the patients experienced less than 25% improvement, 48.5% (n = 16) experienced 25%-74% improvement and 18.3% (n = 6) experienced more than 75% improvement. One patient had severe sensitisation reaction amounting to near erythroderma which resolved completely upon cessation of DPCP therapy. No other adverse reactions were noted in the cohort. DPCP remains a valuable tool in a dermatologist's armamentarium in treating alopecia areata as it is safe, well-tolerated, and shows limited efficacy.

Non-nodal locoregional metastasis in the setting of melanoma includes microsatellites, satellites, and in-transit metastasis (ITM). Micrometastasis can be identified in regional lymph nodes in approximately 30–50% of clinically node-negative patients. Sentinel lymph node biopsy (SLNB) seems to be a feasible and accurate staging procedure, even in patients with few localizations of local recurrence and/or ITM (≤3) without evidence of regional nodal disease. SLNB helps identify patients with a more favorable prognosis, supporting an aggressive therapeutic approach; moreover, it is possible to safely avoid an unnecessary regional lymph node dissection whenever a tumor-negative SLN is found. Patients who present with ITM disease and clinical regional nodal disease need to be strongly considered for systemic therapy as a first-line approach: in these patients, the ITM lesion does not require local intervention in the short term and can be addressed, if the patient remains free of progression. The other option to consider with patients presenting with ITM and regional nodal disease is systemic immunotherapy combined with regional therapy. Locoregional treatments are: carbon dioxide laser, topical diphenylcyclopropenone, topical imiquimod, intralesional PV-10, interleukin-2 chemoablative therapies, electrochemotherapy, isolated limb infusion, hyperthermic isolated limb perfusion, and rarely amputation.

Although the development of successful vaccines against coronaviruses may be achieved, for some individuals the immune response that they stimulate may prove to be insufficient for effective host defence. The principle that a relatively strong contact allergen will have an enhancing effect on sensitisation to a less potent contact allergen if they are co‐administered, may not at first appear relevant to this issue. However, this augmentation effect is thought to be due to the sharing of common or complementary pathways. Here we consider briefly aspects of the shared and complementary pathways between skin sensitisation induced by exposure to a contact allergen and the immune response to viruses, with particular reference to Covid‐19. This relationship leads us to explore whether this principle, which we name here as ‘cooperative immune augmentation’ may extend to include viral vaccination. We consider evidence that even relatively weak contact allergens, used in vaccines for other purposes, can show enhanced sensitisation, which is in keeping with a cooperative augmentation principle. Finally, we consider how the potent contact allergen diphenylcyclopropenone could be employed safely as an enhancer of vaccine responses. This article is protected by copyright. All rights reserved.

Background Alopecia areata (AA) is an autoimmune disorder characterized by transient, non-scarring hair loss with preservation of the hair follicle. It affects nearly 2% of the general population at some point during their lifetime. Extent of the disease can vary widely from localized hair loss in well-defined patches to diffuse or total hair loss, which can affect all hair-bearing sites. Patchy alopecia areata affecting the scalp is the most common type. Objectives The aim of this study is to evaluate the efficacy and safety of topical diphenylcyclopropenone alone and in combination with intralesional steroids or systemic steroids for the treatment of extensive and/or refractory cases of alopecia areata. Patients and Methods The study included 21 patients suffering from alopecia areata during January 2018 till November 2018. They were recruited from the Outpatient Clinic of Dermatology, Ain Shams University Hospital and El-houd EL-marsoud Hospital. All patients gave written consent to participate in this work after explanation of the technique, expectations, possible side effects and alternative treatments. The study was approved by Research Ethical committee of Ain Shams University. Results We found that about three quarters of AA patients were males and majority were young adults aged 15 to 50 years. The duration of the disease was more than one year and mean age of first onset was 15 years. About half of the patients was of refractory type. All patients recalled previous history of AA and 90% treated by combined therapy. Scalp was affected in all patients and eyebrow in half of them while nails were affected in 10%. Mean SALT score at time of presentation was 59%. Dermoscopic examination revealed that majority of the patients (95%) had yellow dots; two third had black dots and vellous hair; while exclamation and short thin hairs were found in approximately one third of the patients. The study found that there is statistically significant difference between mean SALT scores among the three treatment modality groups at start of treatment course specifically between group II (40.6 (±20.9)) and group III (82.5 (±21.7)) (p = 0.04). Conclusion DPCP is an effective and safe treatment of extensive and refractory AA especially with intralesional steroid. Older age at onset of the disease is good indicator for a better prognosis. No statistical significant difference between treatment modalities regarding response stratified by other demographic and clinical feature of AA patients.

Background/aim Alopecia areata (AA) is an inflammatory disease with a genetic and autoimmune basis. Herein, it was aimed to study the efficacy and safety of an immunomodulatory therapeutic agent, diphenylcyclopropenone, while manifesting its association with histopathological features, prognostic factors, and side effects. Materials and methods In this retrospective study, 98 patients (60 males, 38 females) with alopecia, who were referred to the Hair Disease Polyclinic at the Department of Dermatology, between 2011 and 2015, were included. Together with medical histories and dermatological examinations, a skin biopsy for histopathological examination was conducted for all of the patients prior to therapy. Therapeutic success was evaluated on the basis of the hair regrowth percentage. Results Regarding the overall treatment success, 33 (34%) patients had complete response, 16 (16%) had partial response (between 50% and 99%), 27 (28%) had minimal response (between 1% and 49%), and 22 (22%) were nonresponders. Both sexs were equally represented in the outcome. Conclusions There was a significant relation between the severity of alopecia and the treatment outcome (P = 0.038). Patients with AA had significantly better response when compared to those with alopecia totalis and universalis. There was no statistically significant relation with other parameters, such as disease duration, age, sex, atopy history, age of onset, and histopathological features.

Some melanomas develop a striking avidity for lymphatic spread. In spite of multiple recurrences, patients can remain years without visceral metastasis. There is clearly a biologic reason for this lymphotrophic pattern of growth and dissemination, which we have yet to uncover. In-transit metastases have widely diverse clinical presentations and can be a stubborn disease to cure. As a result, a host of treatments exist that should be tailored to the individual patient.

In-transit cutaneous metastases occur in 5% to 10% of patients with melanoma. Recently, topical diphenylcyclopropenone (DPCP) has been described as a treatment option.To evaluate efficacy of DPCP in treatment of in-transit cutaneous melanoma.The authors retrospectively reviewed the records of 13 consecutive patients with in-transit metastases treated with topical DPCP between March 1, 2013, and January 31, 2017. The authors recorded the response of in-transit cutaneous melanoma lesions treated with DPCP measured by clinical examination.Among the 13 patients, 9 patients completed at least a 1-month course of DPCP treatment. Of these 9 patients, 6 (66.7%) maintained either stable disease or had a partial or complete regression, and 3 (33.3%) had progressive disease. Patients with less burden of disease (e.g.,15 lesions) responded more favorably than those with a greater burden of disease (e.g.,25 lesions or plaques). Both patients who received DPCP alone had progression of their cutaneous lesions. One patient who did not become sensitized to DPCP died within 2 months, and his anergy likely reflecting immense burden of disease.Topical DPCP is a low-cost, patient-applied treatment option for in-transit melanoma, most effective for patients with relatively low tumor burden and localized disease.

Background This study investigated predictors of response to topical diphenylyclopropenone (DPCP) immunotherapy in patients with alopecia areata (AA). Objective To identify predictors of response, or resistance, to treatment for AA through clinical observations and serum tests. Methods Eighty four AA patients were treated with DPCP. Serum cytokine levels were measured in 33 AA patients pre- and post-treatment, and in 18 healthy controls, using ELISA assays. Results Of patients, 56.1% responded to DPCP with satisfactory hair regrowth; the response rate was negatively correlated with hair loss extent. Before DPCP treatment, higher serum IFN-γ and IL-12 cytokine levels were observed in AA patients compared to healthy controls. Non-responders to DPCP had significantly elevated serum IL-4 pre-treatment (3.07 fold higher) and lower IL-12 levels compared with responders. After DPCP treatment, non-responders had persistently high IL-4, increased IL-12, negligible decrease in IFN-γ and decreased IL-10. Post-treatment DPCP responders exhibited significantly decreased IFN-γ and IL-12, and increased IL-4 and IL-10. Development of adverse side-effects was significantly associated with higher pre-treatment serum IgE levels. Limitations A small number of subjects were evaluated. Conclusions Potentially, elevated pre-treatment serum levels of IL-4 and IL-12 can be used as unfavorable and favorable predictors of DPCP therapeutic effect, respectively. In addition, pre-treatment elevated serum total IgE may predict increased risk for severe adverse side-effects to DPCP application. Whether serum cytokine expression levels can be used as predictors of response to other forms of treatment is unknown, but it may warrant investigation in the development of personalized treatments for AA.

Introduction Alopecia areata (AA) is a skin disease of unclear etiology. In AA, topical immunotherapy with diphenylcyclopropenone (DPCP) is considered the most effective treatment; however, the most common therapies give unsatisfactory results. Aim To assess the efficacy of a topical application of a solution of DPCP based on the intensity, duration and number of exacerbations of AA and to compare the efficacy of two treatment regimens. Material and methods In this prospective study, 39 patients with AA were enrolled. Group A was treated at weekly intervals and group B at 3-week intervals. Hair loss was assessed by independent dermatologists and documented by photography and dermoscopy. Results After 6 months' therapy, hair regrowth greater than 50% was observed in 21 patients, while worsening, no regrowth, or regrowth of less than 50% was seen in 18 patients. Regrowth exceeding 50% of initial loss was observed in 12 of 17 patients with baseline hair loss < 50%, in 9 of 22 patients with severe alopecia, and in 4 of 9 patients with alopecia totalis. Both groups showed significant improvement with higher efficacy in group B (54%) than group A (46%). Conclusions Treatment at longer intervals may be safer and more comfortable for patients; however, further research is required.

We studied ultrafast photodissociation reaction of diphenylcyclopropenone (DPCP) in solution by time-resolved impulsive stimulated Raman spectroscopy (TR-ISRS) using sub-6-fs pulses. The obtained femtosecond time-resolved Raman data of excited-state DPCP did not show any noticeable spectral change during its lifetime of 180 fs. This indicates that photoexcited DPCP is trapped at the excited-state potential energy minimum before undergoing the photodissociation, which is consistent with the predissociation picture of ultrafast photodissociation reaction of DPCP. The present study demonstrates the high capability of TR-ISRS for structural characterization of short-lived reactive transients that decay within only a few hundreds of femtoseconds.

AIMS To quantify the anti-inflammatory potency of topical corticosteroids and topical calcineurin inhibitors by measuring the contact allergic response to a diphenylcyclopropenone (DPCP) challenge in de novo sensitized human volunteers. METHODS Two randomized, double-blind, vehicle-controlled studies were performed encompassing 76 volunteers: 29 in the first and 47 in the second study. Topical drugs were applied pre- and/or post-treatment in block designs. The compounds were tested simultaneously under occluded patch tests covering DPCP-induced dermatitis. Inhibitory responses were assessed by visual scoring and measurements of the oedema thickness with ultrasound. RESULTS When applied both before and after the DPCP challenge, significant anti-inflammatory effects were seen in descending order for tacrolimus 0.1% ointment, clobetasol propionate ointment, betamethasone valerate ointment and hydrocortisone butyrate ointment, while pimecrolimus cream, hydrocortisone ointment and vehicles had no significant effect. Only tacrolimus ointment (P

Background: Diphenylcyclopropenone (DPCP) immunotherapy for viral warts has been used for many years, but no studies have analyzed the treatment effects of DPCP alone, without the use of conventional therapy before immunotherapy. Objectives: We evaluated clinical efficacy of DPCP monotherapy compared to cryotherapy and pulsed dye laser (PDL) therapy. We also assessed the impact of initial sensitization on clinical response. Methods: We retrospectively analyzed the medical records of 250 patients with multiple viral warts between January 2008 and December 2015. Results: The DPCP-only group (n = 43) showed a lower clinical response (75.6%) than the cryotherapy-only group (n = 171, 89.8%, P < .01) and PDL-only group (n = 36, 90.3%, P < .01). The positive clinical response was 76.3% (119/156) in the successful sensitization group (n = 21) and 74.4% in the failed sensitization group ( P = .870). Conclusions: DPCP monotherapy has a lower clinical response than conventional therapy. Initial sensitization to DPCP does not predict a failed response with continued immunotherapy for viral warts.

Introduction Topical immunotherapy is frequently used in the treatment of alopecia areata (AA) although few studies report long-term follow-up. Our goals were to determine the efficacy and the prognostic factors of topical immunotherapy in a large cohort of patients with AA treated in the departments of Dermatology and Venereology of Bergamo, Como and Pavia, from 1978 to January 2016. Methods A total of 252 patients with AA were evaluated retrospectively. Results All our patients developed an allergic reaction to a 2% solution of dinitrochlorobenzene (DNCB) or squaric acid dibutylester (SADBE) or diphenylcyclopropenone (DPCP). No patients discontinued therapy because of side effects. In total 112 patients (44.05%, p

Alopecia areata (AA) is a common, inflammatory, nonscarring type of hair loss. Significant variations in the clinical presentation of AA have been observed, ranging from small, well-circumscribed patches of hair loss to a complete absence of body and scalp hair. Patients affected by AA encompass all age groups, sexes, and ethnicities, and may experience frustration with the unpredictable nature of their disease for which there is currently no definitive treatment. The cause of AA remains incompletely understood, though it is believed to result—at least in part—from a loss of immune privilege in the hair follicle, autoimmune-mediated hair follicle destruction, and the upregulation of inflammatory pathways. Patients with AA frequently experience marked impairment in psychological well-being, self-esteem, and may be more likely to suffer from psychiatric comorbidities. Part one of this two-part continuing medical education series describes the epidemiology, clinical evaluation, prognosis, and recent advancements in the understanding of the pathogenesis of AA.

Alopecia areata (AA) is an autoimmune, nonscarring alopecic disorder with a lifetime prevalence of about 2%.1 This disorder presents with varying amounts of hair loss, ranging from focal patchy loss to entire scalp and body hair loss as in alopecia totalis (AT) and alopecia universalis (AU), respectively. Severe subtypes are difficult to treat and contribute to significant patient burden. Current treatment strategies center on immunomodulation, both systemically and topically. Systemic therapies such as oral corticosteroids, cyclosporine, and methotrexate can be efficacious, with regrowth rates between 30% and 76%.2 However, side-effect profiles, lengthy treatment durations, and relapse rates after discontinuation of therapy limit their use.2 Newer Janus kinase (JAK) inhibitors appear promising, yet patients relapse after treatment cessation, and cost is often prohibitive.3 Topical glucocorticoids offer variable efficacy; 17.8% of patients with AT or AU had long-term regrowth with clobetasol use.4 Topical calcineurin inhibitors have not demonstrated efficacy, perhaps because of insufficient depth of penetration.5 Intralesional triamcinolone at concentrations of 2.5 to 5 mg/mL are considered first-line therapy with regrowth seen in 61% of subjects with AT at 6 weeks and minimal side effects.2, 6 An additional therapeutic option used for more severe forms of AA is the topical immunomodulator, diphenylcyclopropenone (DPCP). Although the exact mechanism of DPCP is unknown, its resultant allergic contact dermatitis is thought to cause antigenic competition and an alteration of the inflammatory cytokine milieu.2, 7 In one retrospective study of 50 patients treated with DPCP, terminal hair regrowth of 50% or more was seen in 56% and 71% of those with AU and AT, respectively.7 Anthralin (dithranol), available in 0.25% to 1% concentrations, is another topical treatment option. Anthralin functions via the production of a localized irritant dermatitis with resultant pruritus, erythema, and scale. Patients who do not have a robust inflammatory response to anthralin may not achieve significant therapeutic response.2 Response rates with anthralin in AA and AT are between 25% and 75%.2 Combination treatment strategies may provide a more robust therapeutic response, such as the combination of minoxodil with topical glucocorticoids and anthralin with DPCP.2, 8 Calcipotriol/calcipotriene is a topical vitamin D3 analogue commonly used in plaque psoriasis. Recently, a significant benefit of combination therapy with calcipotriol and 5-fluorouracil has been identified in the treatment of actinic keratoses.9 When used together, these medications show a synergistic mechanism of action, perhaps because of calcipotriol's induction of antitumor immunity and allergic skin inflammation via thymic stromal lymphopoietin cytokine.9 The efficacy of this combination offers a potential corollary for the treatment of additional dermatologic conditions in which immunomodulation plays a key role. The combination of anthralin and calcipotriene may likewise demonstrate synergistic effects in the treatment of AA.

Background: Current treatments for in-transit melanoma (ITM) metastases are frequently invasive and do not improve overall survival. Recently, there has been increasing investigation into the use of topical agents. Diphenylcyclopropenone or diphencyprone (DPCP) is a novel, topical therapy that has been reported to have immune-sensitizing properties useful in the treatment of ITM. Objective: To assess the clinical outcomes of patients treated within a prospective, non-randomized, non-comparative study using DPCP for cutaneous ITM metastases. Methods: A review was conducted assessing the outcomes of 58 patients prospectively treated using DPCP. Patients had satellite or in-transit disease (stage IIIB+), with all lesion morphology types included. The patients were treated through a single, specialized clinic with regular outpatient follow-up. DPCP was topically applied as an aqueous cream in 0.005-1% concentrations once to twice per week for up to 24-48 h of duration. To assess variables associated with response, a per-protocol statistical analysis was performed. Results: Fifty-four patients were treated who satisfied eligibility criteria for analysis. The overall response rates were as follows: complete response 22%, partial response 39%, stable disease 24% and progressive disease 15%. The mean time to complete response was 10.5 months, mean duration (disease-free interval) 12.3 months and recurrence rate in complete responders 41%. Lesion morphology was predictive of clinical benefit with a higher response in epidermotropic disease (P < 0.05). Conclusions: DPCP provided a well-tolerated, convenient and efficacious treatment for cutaneous ITM metastases. Identifying patterns of response may assist treatment selection and improve patient-rated outcomes.

Background Few treatment modalities are available for treating alopecia areata (AA) of the eyebrow. Due to the anatomical proximity of the eyebrows to the eyes, safety issues and side effects should always be taken into consideration when choosing the treatment modality. This study was designed to examine the efficacy of superficial cryotherapy on patients with AA of the eyebrow. Methods Superficial cryotherapy was performed every other week on the right eyebrow (SC-treated) in a total of 20 patients who had been previously treated with diphenylcyclopropenone (DPCP) immunotherapy on the scalp. No specific treatment was performed on the left eyebrows as a control. The degree of eyebrow recovery was compared in 15 patients who continued to receive more than 10 superficial cryotherapy treatments (5 months of treatment) on their right eyebrow. Results Hair density was significantly increased on both treated and control eyebrows after 5 months of treatment compared with the pretreatment density; moreover, the SC-treated eyebrows exhibited a significantly greater increase in density than the control eyebrows. Although hair thickness in the control eyebrows did not change significantly over the treatment period, hair thickness of the SC-treated eyebrows showed a statistically significant increase at months 3 and 5. Conclusions Superficial cryotherapy is associated with minimal to no adverse events and exhibits high compliance and relatively good efficacy. Thus, this treatment is an important additional option for patients with AA of the eyebrow.