P#11   Anthralin therapy for DPCP-resistant severe alopecia areata

Gwang Seong Choi and Gyun Lim. Dept of Dermatology, Inha University, Incheon, Korea

Alopecia areata is a relatively common disorder but the exact pathogenesis is still unknown and there is no satisfactory treatment. We treated 7 patients with alopecia areata who were refractory to PUVA, topical and systemic steroid, steroid injection, and diphencyprone. Their ages ranged from 7 to 36 years (mean, 17.6 years) and the duration of alopecia was from 4 to 125 months (mean, 44.7 months). Two patients had severe extensive alopecia (>90% bald area of the scalp), whereas 5 patients had alopecia totalis. The concentrations of anthralin pastes used for the treatment were 0.5%, 0.75%, 1%, and 1.5%. Half of the scalp was randomly designated as the treatment site, whereas the other half served as a control region. Anthralin pastes were applied at the half of the scalp for 1 hour every nights. Treatment was initiated with 0.5% anthralin paste. If there was no regrowth of terminal hair for 3 months post treatment or erythema, pruritus, and scaling were not found, we changed the concentration. Clinical response was rated according to the grading system proposed by MacDonald Hull and Norris: grade 1, "regrowth of vellus hair"; grade 2, "regrowth of sparse pigmented terminal hair"; grade 3, "regrowth of terminal hair with alopecia patch"; grade 4, "regrowth of terminal hair on the whole scalp". Regrowth of terminal hair occurred in 3 patients after 1 to 5 months (mean, 2.7 months) post treatment. They showed grade 4 response. Two patients discontinued the treatment because they just gave up the treatment. In six patients, eczematous reactions consisting of erythema, itching, and scaling at the site of application as well as skin staining were observed. In conclusion, topical anthralin therapy should be considered in those patients with DPCP-resistant severe alopecia areata.