L-06   MANAGEMENT OF ALOPECIA AREATA: A CLINICIAN'S VIEW

R. Happle, Dept. Dermatology, Philipp University Marburg, Marburg. Germany.

Treatment of alopecia areata is still a difficult task for every dermatologist. After 27 year of experience with topical immunotherapy, I conclude that this is the only approach with proven long-term effectiveness. If the patient should not respond satisfactorily to diphencyprone, it is worthwhile to switch to squaric acid dibutylester, or vice versa. In fact, replacement of one potent contact allergen by the other one has given good results in numerous cases. In the successfully treated patients, a unilateral response is usually seen within the first three months of treatment. When no unilateral hair regrowth is observed within a period of 6 months, we advise to discontinue the treatment because a satisfactory response becomes highly unlikely. (The Vancouver group of Dr. Shapiro, however, is advising a tentative treatment period of 1 year). In cases of extensive or total alopecia areata, a complete or almost complete hair regrowth can be expected in about 50% of cases. As an important side effect, hyperpigmentations or vitiligolike hypopigmentations may occur, especially in more darkly pigmented individuals. We do presently not treat children under the age of 10 years. However, no age limit is today observed in the United Kingdom and the USA. Systemic administration of corticosteroids is considered obsolete because the expected therapeutic effect does not outweigh the dangerous side effects. In my view, this holds likewise true for the high-dose pulse corticosteroid therapy as presently advocated by several groups. It is surprising that topical immunotherapy with potent contact allergens has remained, during more than a quarter of a century, the most effective method for the treatment of alopecia areata. Hopefully, this method will soon be replaced by more specific approaches in the form of application of biologicals that, for example, may either exert an anti- CD44v10 effect, or inhibit apoptosis in the Fas-FasL system, or induce a specific tolerance.