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Review of Topical Immunotherapy Alopecia Areata Hair Regrowth

The most severe types of the autoimmune disorder Alopecia Areata are typically considered untreatable, given the treatments which are available have not shown themselves to be truly, consistently effective.

Whilst Alopecia Areata treatment can be beneficial to the mildest form, which causes patchy hair lossto the scalp only, Alopecia Totalis and Alopecia Universalis, which cause baldness of the head and from head to toe respectively, currently have limited options.

Topical immunotherapy is commonly used but has previously shown itself to have wildly varying success rates when it comes to hair regrowth. It involves sparking what is essentially an allergic reaction in the skin, in order to encourage active hair growth from the dormant follicles.

Swabs cotton buds qtips topical immunotherapyAs we prepare for what could be the first clinically-proven, medical board approved and licensed forms of treatment for all these forms of autoimmune alopecia, to potentially become available in 2021, a team has studied whether there is any merit in a common existing treatment method.

Specifically, researchers from the Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine in Korea have undertaken a systematic review of how effective topical immunotherapy can be for regrowing hair. This involved summarising the findings of many previous studies where topical – or ‘contact’ – immunotherapy, where treatments are swabbed onto the skin – were used, in order to arrive at a more informed conclusion.

Measuring hair regrowth from topical immunotherapy

Published on 1st August 2018 in the JAMA Dermatology medical journal (doi:10.1001/jamadermatol.2018.2312), the researchers set themselves a question to answer: ‘At what rate is contact immunotherapy associated with satisfactory hair regrowth in patients with alopecia areata?’

In order to find a meaningful response the team analysed 45 studies comprising 2,227 patients with a diagnosis of Alopecia Areata (AA), Alopecia Totalis (AT) or Alopecia Universalis (AU), who had been treated using solely topical immunotherapy. Data from articles published prior to 20th November 2017 was taken from a search of the MEDLINE database, Embase, and Cochrane Library, using the search terms areata, totalis, universalis, sensitizer, sensitization, immunotherapy, DPCP, diphenylcyclopropenone, diphencyprone, SADBE, and squaric.

The results were noted as follows:

– any hair regrowth observed = 74.6% (AA), 54.5% (AT/AU) = 65.5% overall mean rate of hair regrowth

– minor regrowth observed = 64.9% (AA), 45% (AT/AU) = 55% overall mean rate of hair regrowth

– major regrowth observed = 56.1% (AA), 28.7% (AT/AU) = 42.4% overall mean rate of hair regrowth

– total hair regrowth observed = 42.6% (AA),  24.9% (AT/AU) = 32.3% overall mean rate of hair regrowth

It was further stated that where the extent of the hair loss was 50% or greater, where there was an atopic history or where nail dystrophy was also present, there was likely to be a less promising response.

What was not stated was how long these hair regrowth results lasted – Alopecia Areata is known to recur – how long the topical immunotherapy treatment was used for. However, researchers did note that ‘Recurrence rates were 38.3% among patients receiving maintenance treatment and 49.0% among those not receiving maintenance treatment’ – suggesting this hospital-based treatment was on-going in some cases.

From studying the types of immunotherapy administered in each case, it was concluded that diphenylcyclopropenone or squaric acid dibutyl ester was ‘preferred’ as a treatment for Alopecia Totalis and Alopecia Universalis.

Having established that hair regrowth outcomes may be influenced by a number of factors, as outlined, the Korean researchers felt that improving patient education regarding topical immunotherapy’s success rates may lead to them sticking with it for longer and, therefore, experiencing better results.

Alopecia Areata treatment for patchy hair loss

Currently there are a number of Alopecia Areata treatment options for people aged 16 years and over with the mild-to-moderate, patchy, scalp-only form of Alopecia Areata.

The approaches for people with AT and AU, or those under 16 years of age can be less effective at the moment and require consultation with their GP or dermatologist.

However, a number of treatments for all types of Alopecia Areata, including the most extensive, are currently in development and are being ‘fast tracked’ by the FDA in order to ensure their reviews are conducted as quickly as possible.

It is hoped that the first MHRA licensed and FDA approved treatments for Alopecia Areata, in all its forms, may be available as soon as 2021 and we will continue to publish updates on those working towards this goal, here on the Belgravia hair loss blog.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.


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