Overview
This is an autoimmune disease of the skin. The scalp is often affected. It presents as one or more bald patches on any part of the scalp. It is often not preceded by any redness or associated with itch. Bunches of hair just fall off suddenly over a few days leaving behind completely bald patches. The underlying skin appears perfectly normal. The cause of alopecia areata is unknown. Most patients recover spontaneously after several months. In severe cases, the whole scalp may be affected leading to complete baldness. The disease is rarely associated with other skin disease e.g. thyroid disease.
Detection & Treatment
The treatment of alopecia areata include topical steroids, steroid injections as well as chemical treatments such as diphencyprone or diphenylcyclopropenone (DCP).
How does DCP work?
DCP works by inducing contact dermatitis. The body's immune system is stimulated causing inflammation on the surface of the skin. By diverting the white blood cells away from the hair bulb, the hairs can re-grow. DCP does not work in every patient, but reports suggest that up to 50% of people who use it will obtain significant re-growth of their hair.
What would you expect if your doctor put you on DCP?
First Visit
DCP treatment usually involves making you allergic to this chemical by "sensitizing" you to the chemical DCP. This chemical is painted on a small patch on your scalp and left on for 24 hours.
After 24-hours, you should remove the patch by wiping the chemical with a tissue before washing the area in the shower. An itchy area or even blister will develop in 3 to 5 days where the DCP is applied. This itchy area will fade in 2-3 weeks.
Second visit (2 weeks after sensitization)
You need to see the doctor 2 weeks after the "sensitization" period. Your doctor will examine you and decide if DCP will work for you. If you have a reaction to DCP (you developed an itch or blister 3-5 days after "sensitization"), this means that you have been successfully sensitized to DCP.
Subsequent visits (usually applied weekly)
DCP is usually applied once a week. DCP comes in many concentrations (0.0001%, 0.001%, 0.01%, 0.05%, 0.1%, 0.5%, 1% etc) and your doctor will choose the best concentration to start treating you with. In the treatment room, your nurse will apply DCP to your scalp. After treatment, you should keep the treated areas covered. After 24 hours, you will be required to wash off all the remaining chemical from your scalp.
Once you have been sensitized to the DCP, you will get a rash wherever it touches you. So you must be careful when you wash away the remaining chemical to make sure that it does not come into contact with other parts of your body.
Care Management
What can you expect after each treatment?
One to two days after your treatment, you may experience itching, buming, blistering on the scalp and may even look like a mild sunburn. Different people react differently and some people will only have a mild redness and slight itch, whilst others may get a very severe itch and even few blisters. A satisfactory reaction is for the DCP to cause mild redness, tolerable itchiness and/or mild scaliness lasting 24-48 hours.
The redness and itch is then allowed to subside, and the DCP is applied each week. DCP will be continued until the bald area has completely regrown. This will usually take several months. If you get a strong reaction such as blistering, intense or intolerable itch, and/or extensive scaliness, please inform your nurse and no treatment will be done until your reaction settles. Some patients will develop painful swellings (lymph nodes) at the back of the neck. It is generally benign. Please see your doctor.
Medical Reviews
Your doctor will review you at regular intervals after starting treatment. He will adjust the concentration of DCP applied according to your response to the previous concentration. DCP treatment should be continued for at least 6-12 months before it is considered unsuccessful.
When the treatment is deemed successful and you have achieved complete re-growth, your doctor will either reduce the frequency and put on a maintenance regime or stop the treatment completely.
Side Effects
Treatment with DCP is usually safe and any side effects is usually due to hypersenstivity to the chemical. You can develop redness, itch, blisters and white or brown patches. If you are extremely sensitive to the chemical you might even develop rashes on other parts of the body, not exposed to the chemical. If this happens, and it is extensive and severe, you are required to stop the treatment and to consult your doctor immediately.
At all times when on treatment, YOU MUST NOT BE PREGNANT OR BREASTFEEDING. The effects of DCP in pregnancy is unknown. Should you be pregnant while on treatment, you should stop your DCP treatment immediately and inform your doctor.
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