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in addition to lymphadenopathy&#44; pruritus&#44; hyperpigmentation&#44; and flu-like symptoms&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Drug utilization varies&#44; lacking methodological standardization&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> This service uses a methodology based on the principles of ACD&#46; This case report aims to demonstrate the steps of DPCP use in AA&#46; This standardization allowed comparing data and reducing side effects due to drug inappropriate use&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The product is purchased at 2&#37; in acetone and stored in the refrigerator in a dark bottle&#46; The dilutions are prepared during the appointments and applied weekly with moistened flexible swabs&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 44-year-old male with universal AA was sensitized with 2&#37; DPCP on 2&#8239;&#215;&#8239;2&#8239;cm filter paper on the back for 48&#8239;hours&#44; inducing the ACD induction phase&#46; After 2 weeks&#44; he was submitted to a patch test with DPCP&#44; at 0&#46;1&#37;&#59; 0&#46;05&#37;&#44; and 0&#46;02&#37; concentrations&#44; with readings after 48 and 96&#8239;hours&#44; and responses 3&#43;&#44; 2&#43; and 2&#43; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; respectively&#44; according to the previously established standardization&#46; The 0&#46;02&#37; concentration was used on the scalp&#44; where it remained covered and unwashed for 48&#8239;hours&#46; The concentration was increased weekly to 0&#46;1&#37; when moderate pruritus and erythema were obtained&#46; Repilation was acceptable after 24 weeks&#44; without severe reactions &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The patch test assesses whether there was sensitization to the product and predicts the best concentration with which to start treatment&#44; choosing the one with the lowest positivity&#44; minimizing adverse effects&#46; If the responses are intense&#44; the concentrations are reduced&#44; and sometimes the applications are spaced out at intervals of two to four weeks&#46; The concentrations depend on the response of each individual&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Therapeutic failure&#44; that is&#44; the absence of repilation&#44; is considered after 180 days of regular application&#46; If there is a response&#44; the applications are maintained until the best possible effect is attained &#40;up to one year&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">DPCP is a drug that provides good response rates in severe cases&#59; however&#44; the protocols are not yet standardized&#46; Due to common and sometimes severe side effects&#44; strict monitoring of sensitization and control of the concentrations are necessary throughout the treatment&#46; Moreover&#44; no industry manufactures DPCP in accordance with regulatory standards for drug development&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the present environment&#44; there is no regulation for its use&#44; although it has been part of the therapeutic arsenal for AA treatment for many years&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Andressa Sato de Aquino Lopes&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Rosana Lazzarini&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied case&#59; effective participation in research orientation&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Treatment of alopecia areata with Diphenylcyclopropenone: methodology based on the principles of allergic contact dermatitis
Andressa Sato de Aquino Lopes
Autor para correspondência
dressa_sato@hotmail.com

Corresponding author.
, Rosana Lazzarini
Medical Department of Clínica de Dermatologia, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diphenylcyclopropenone &#40;DPCP&#41; is a chemical substance that induces a cellular immune response and&#44; therefore&#44; allergic contact dermatitis &#40;ACD&#41;&#46; Its action is based on the concept of antigenic competition&#44; inducing the formation of TCD8 lymphocytes&#44; which inhibit the active perifollicular immune response&#44; allowing hair growth&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">DPCP is a therapeutic option for alopecia areata &#40;AA&#41;&#44; especially in extensive cases&#44; with a variable response&#44; but repilation rates in more than 50&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Side effects are common&#44; sometimes severe&#44; such as acute eczematous reactions&#44; in addition to lymphadenopathy&#44; pruritus&#44; hyperpigmentation&#44; and flu-like symptoms&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Drug utilization varies&#44; lacking methodological standardization&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> This service uses a methodology based on the principles of ACD&#46; This case report aims to demonstrate the steps of DPCP use in AA&#46; This standardization allowed comparing data and reducing side effects due to drug inappropriate use&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The product is purchased at 2&#37; in acetone and stored in the refrigerator in a dark bottle&#46; The dilutions are prepared during the appointments and applied weekly with moistened flexible swabs&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 44-year-old male with universal AA was sensitized with 2&#37; DPCP on 2&#8239;&#215;&#8239;2&#8239;cm filter paper on the back for 48&#8239;hours&#44; inducing the ACD induction phase&#46; After 2 weeks&#44; he was submitted to a patch test with DPCP&#44; at 0&#46;1&#37;&#59; 0&#46;05&#37;&#44; and 0&#46;02&#37; concentrations&#44; with readings after 48 and 96&#8239;hours&#44; and responses 3&#43;&#44; 2&#43; and 2&#43; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; respectively&#44; according to the previously established standardization&#46; The 0&#46;02&#37; concentration was used on the scalp&#44; where it remained covered and unwashed for 48&#8239;hours&#46; The concentration was increased weekly to 0&#46;1&#37; when moderate pruritus and erythema were obtained&#46; Repilation was acceptable after 24 weeks&#44; without severe reactions &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The patch test assesses whether there was sensitization to the product and predicts the best concentration with which to start treatment&#44; choosing the one with the lowest positivity&#44; minimizing adverse effects&#46; If the responses are intense&#44; the concentrations are reduced&#44; and sometimes the applications are spaced out at intervals of two to four weeks&#46; The concentrations depend on the response of each individual&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Therapeutic failure&#44; that is&#44; the absence of repilation&#44; is considered after 180 days of regular application&#46; If there is a response&#44; the applications are maintained until the best possible effect is attained &#40;up to one year&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">DPCP is a drug that provides good response rates in severe cases&#59; however&#44; the protocols are not yet standardized&#46; Due to common and sometimes severe side effects&#44; strict monitoring of sensitization and control of the concentrations are necessary throughout the treatment&#46; Moreover&#44; no industry manufactures DPCP in accordance with regulatory standards for drug development&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the present environment&#44; there is no regulation for its use&#44; although it has been part of the therapeutic arsenal for AA treatment for many years&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Andressa Sato de Aquino Lopes&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Rosana Lazzarini&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied case&#59; effective participation in research orientation&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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