121 A case of severe dermographism to diphenylcyclopropenone therapy for alopecia universalis

N. Skrebova, Y. Nameda, H. Takiwaki, S. Arase Dept. of Dermatology, The University of Tokushima School of Medicine, Tokushima, Japan

Most side effects associated with topical sensitizers in the treatment of alopecia areata do not require suspension or termination of therapy. Here we report a case of a 19-year-old Japanese man with an 11-year history of alopecia universalis. 3 weeks after initial sensitization with diphenylcyclopropenone (DPCP) 1% eth. on his left forearm, a trial was made on the scalp with a 0.003% DPCP solution, open patch tests on the back having established a minimum erythema dose of 0.005%. After the 1 st application of 0.003% DPCP solution to the whole scalp, the patient developed acute contact dermatitis at the test site, together with widespread severe dermographism and pressure-induced urticaria at the site of stimulus. Topical immunotherapy with DPCP was discontinued. The scalp contact dermatitis receded in 2 weeks after the usage of the topical corticosteroid. For 3, 5 months the severity of the urticarial reaction and the efficacy of treatment were assessed by means of the dermographism test and the pressure test before and after treatment with oral H1 antihistamines. The course of these side effects in our patient suggests that a Type Iassociated severe urticarial reaction persisting for a long period can be provoked by topical immunotherapy. Therefore, precautions must currently be taken in the therapeutic use of potent sensitizers such as DPCP.