Alopecia treatments: topical immunotherapy

Topical immunotherapy, also known as contact immunotherapy, was talked about by a few of the young people we interviewed as a treatment for alopecia areata. This treatment is when a chemical (such as diphencyprone/DPCP) is applied to the skin to irritate it and cause an allergic reaction in order to stimulate hair growth.

Rosie described the process as “a liquid that effectively got painted onto my scalp.” Hannah says it works by trying to “divert” the focus of the immune system away from the hair follicles. Rosie says topical immunotherapy worked well and her hair regrew but later fell out with the stress of exams. Rosie had to see her dermatologist every 10 days for the treatment. Over time, the strength of the chemical DPCP was increased which gave Rosie an itchy, “raised, rashy effect for a few days.”

Lots of people had been offered topical immunotherapy but didn’t want to develop dermatitis (eczema) on the areas being treated. Grace says her skin is sensitive and Emma has had eczema since childhood, so both worried it would be too uncomfortable for them. Beth and Grace decided against topical immunotherapy as they thought it would be too irritating to wear a wig after the treatments.

Michael didn’t have topical immunotherapy because he would have had to travel back to his family home from university to go to his dermatologist weekly for treatments, which would have been “quite a commitment”. Hannah turned down topical immunotherapy as she heard the success rates were about the same or lower than steroid injections.

Meghan hopes to have topical immunotherapy soon, but thinks she probably won’t be able to go swimming or dye the rest of her hair during treatment.

Beth isn’t currently using treatment for her alopecia, but was previously offered topical immunotherapy.

Age at interview 24

Gender Female

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They offered to irritate my scalp, so it would be like a huge-, from what I can remember, it would be like a huge allergic reaction. And you weren’t allowed to- you- basically it was- the end line was I wouldn’t be allowed to wear my hair and it would be extremely uncomfortable, and it might not work. So, and he said like, The likelihood of it not working is quite strong. So I was like, Actually, well, is it worth me not doing, or going out, or seeing anyone for like three weeks to have a really itchy head and really crap time of it? Or to just deal with it? So, because it probably wouldn’t work anyway.

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Professor Moss talks about topical immunotherapy using the drug diphencyprone (DCPC).

Gender Female

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There is another way of suppressing the immune system in the scalp, to try and improve the alopecia areata, and that is with a product called diphencyprone. Which actually, it sounds a bit paradoxical really, it actually promotes an immune response in the scalp. So it’s an irritant, it produces an immune reaction, it produces some inflammation and that inflammatory response kind of interferes with the immune response that’s causing the alopecia. And that does seem to work. So people have that treatment and it does seem to work. The downsides are that it has to be done in hospital because it’s quite a toxic substance. It has to be painted on and then you wait a few days until the body starts to recognise it, and then you get a reaction. You get like a dermatitis on the scalp which quite-, can be quite unpleasant. And then you have to have repeated treatments, applying the stuff. Which can be done at home after the first few times. And each time you apply it, you get an allergic reaction to it, so you get that inflammation, dermatitis, in the scalp again. And that can improve the growth, it can kick start the alopecia into recovery. And that is quite widely used.

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Grace doesn’t want to try topical immunotherapy. She thinks it would be more difficult for her than the steroid injections were.

Age at interview 18

Gender Female

Age at diagnosis 10

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There’s only the really one that I haven’t and that was the irritant applied to the scalp. Because I have quite a high pain threshold, so I didn’t really mind the injections or anything like that, because it was kind of like brace yourself, it’s going to be worth it. It’s kind of a sharp scratch, isn’t it? It’s like getting a piercing or getting some blood taken, which I have quite regularly because they’re like, Oh yeah, your iron levels might have changed, we’ll check these, or like, Your glucose levels. So, I have loads of blood tests as well but nothing ever changes. But yes, so I was just like, Oh, let’s just do it, do it, yeah, and then so, I didn’t mind that. So, the irritant I didn’t really fancy because it sounded really uncomfortable, which for me is so much different than pain if that makes sense?

OK

So, I knew that the injections would be kind of painful for a short amount of time, and that it might be a little bit sore afterwards, but if you kind of cover it up and we let it heal and stuff it will be fine. Whereas it sounded I don’t know whether I got completely the wrong end of the stick, but this irritant sounded really uncomfortable, and that I would be kind of un-, this sustained uncomfortableness for a long-long amount of time. So, I just really didn’t fancy that [laughs], and I kind of thought is this worth it even if it doesn’t work?’ So, I think the short amount of time that the injections I thought right, OK, I can do this’, compared to the irritant. Well I was like nah, I don’t think this is for me. The thought of these-, sitting there and being uncomfortable, I don’t think it would be worth it. I’d rather-, and then the steroids and stuff, they were fine because I didn’t react badly to them at all. I don’t even think I noticed kind of the side effects at all, which is very good for me, but obviously might be different for other people. But yeah, it’s only really the irritant I’ve turned down.

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