Is DPCP effective for children and adults?
DPCP in Children: What is the evidence?
WELCOME & INTRODUCTION
Welcome to the Outpatient DPCP Program at Donovan Medical Whistler. This program is designed for patients with hair loss specifically due to alopecia areata. It is not a treatment for other types of hair loss.
We have created an outpatient program that mirrors the outpatient DPCP program at several academic dermatology departments. Rather than having the requirement of weekly visits to a hospital, patients can apply DPCP treatments at home - usually with assistance from a family member, parent, spouse or friend. Dr Donovan and his team are available 24 hours a day to help if assistance is needed.
At present, outpatient DPCP treatment through Dr Donovan's Whistler clinic is available only to Canadians. We advise all patients interested in DPCP treatments to check if DPCP is offered in their home city. DPCP may be offered by your local dermatologist and this may provide an alternative to our outpatient DPCP program.
HOW DOES THE OUTPATIENT DPCP PROGRAM WORK?
All patients participating in the Whistler outpatient DPCP program MUST BE SEEN FIRST at the Whistler office for initial evaluation, orientation and administration of the first dose. Thereafter, our entire team of receptionists, nurses and physicians provide 24 hour care to patients and families applying the DPCP at home as outpatients. Dr. Donovan provides DPCP prescriptions to patients that they can take to their local pharmacy. We advise all patients with private drug coverage to be sure to check with their insurer to determine if DPCP prescriptions will be covered by the patient's drug plan. Prescriptions for DPCP are valid only in Canada and we therefore generally limit the program to Canadians with alopecia areata.
Dr Donovan and our staff periodically check in with patients while they are receiving DPCP and patients will have our staff contacts should they need them at any time.
Initial Consultation (in Whistler): $ 850
Follow up Visits: $ 650
All individuals requesting entry into the Vancouver DPCP Program MUST BE SEEN FIRST in Whistler, BC for an initial consultation, teaching and the first application of DPCP. Thereafter, home application is possible.
1. What is DPCP?
DPCP is a liquid chemical which is applied to the scalp. It causes an allergic reaction on the skin and therefore it must not be allowed to touch any skin surface EXPCEPT the scalp.
DPCP is therefore used on purpose to cause an allergic response on the scalp. This “tricks” the immune system into mounting a response against the DPCP chemical rather than against the hair. This gives the hair a better chance to start growing back.
2. How is DPCP prescribed?
The very first dose is a 2 % solution which is applied to a small coin-shaped area on the scalp. Generally, this first dose is applied in the clinic by Dr. Donovan or his nurses. At all times DPCP is applied, gloves must be worn. The scalp can be washed in 48 hours. We strongly recommend allowing the DPCP to remain unwashed for 48 hours
Two weeks after visiting the clinic for the first application, patient will then start a very low dose of DPCP (0.001%) at home. This is applied (using gloves) with a q tip to the entire scalp. We can't emphasize enough the importance of wearing gloves and even eye protection to ensure the medication does not splash. Again, let it remain on the scalp for 48 hours before washing out.
DPCP is then applied on a weekly basis.
If there was no itching or burning, we advise increasing the DPCP dose to 0.01%. If there was significant itching, burning or irritation, then the dose is kept the same. In general, patients should be itchy for 2 days – the day of treatment and the following day. We do not want patients itchy for the rest of the week.
3. HOW DO WE GO UP in the various CONCENTRATIONS?
The following is the treatment ladder for applying DPCP. The medication is applied weekly except the first dose (where a full two week wait is needed)
2 % ( THIS IS THE STARTING DOSE JUST TO A COIN SHAPED AREA)
0.001 % (applied 2 weeks later and continued weekly until the scalp is no longer itchy)
0.01 %
0.02 %
0.05 %
0.1 %
0.2 %
0.35 %
0.5 %
0.75 %
1 %
1.5 %
2 %
2.5 %
3 %
4. Can I use DPCP with other treatments?
DPCP cannot be used with topical steroids (except to stop an overly strong reaction) Ask Dr. Donovan if you are not sure what a topical steroid is. You might have been using this for your alopecia areata in the past, but it must now be stopped.
DPCP can be used with Minoxidil lotion – either 2 % of 5 %. Dr Donovan will tell you if he wants you to use minoxidil or not.
DPCP can sometimes be used with other medications Dr. Donovan will prescribe if he feels it might be beneficial
5. Who should not use DPCP?
Dr. Donovan does not prescribe DPCP for several reasons, including if
You have a history of a severe reaction to it in the past
If you have extreme eczema of the skin
You are pregnant or plan to become pregnant within 1-2 years.
6. When will I see results if the DPCP is helping?
Hair growth can be seen in about 12 weeks, but can occur earlier. If you have "active" alopecia areata, you may have hair loss before you get hair growth. White colored hair may appear first followed by darker hairs
7. What side effects are possible with DPCP?
Dr. Donovan and his nurses will review the side effect of DPCP with patients who join the program. In general, one should think of DPCP like you would think of “poison ivy”. Any reaction you can get with poison ivy you can get with DPCP.
Here are a following reactions that can occur:
Rash on the scalp – (this is expected)
Swollen lymph nodes (swollen glands) on the neck – this is expected and not serious
Full body rash if the DPCP is spread
Blisters on the scalp or body
Pigmentation changes on the scalp – some areas lighter and some areas darker
8. What should I also know about DPCP?
It should not be used in pregnancy and should not be used if breast feeding
9. What side effects should prompt me to STOP DPCP and get medical advice?
Stop taking DPCP and get medical help if you develop hives, shortness of breath, swelling in the lips or feel unwell.
Stop if you have any concerns at all
10. How long do you have to use DPCP? is it a for life treatment?
If DPCP proves helpful to grow hair, some patients use DPCP for 1-2 years, and then reduce their use. Others use it periodically for life to maintain hair. Some patients will regrow with DPCP but lose it again down the road.
11. For 48 hours after applying can you touch scalp can you put a wig or a cap on?
A wig can be put on immediately after. But the scalp can not be touched.
12. Does DPCP help with lashes or eyebrows?
We rarely use the DPCP for the eyebrows. It is never used on the eyelashes and must never ever be used near the eyes.
13. Is the DPCP applied to bald spots or the whole head?
The DPCP is applied wherever there are areas of alopecia areata
14. What happens to my hair if I stop?
The goal of treatment is always to try to reduce the DPCP and try eventually to stop if the hair is growing back. But for some patients, stopping leads to hair loss again. There is no formula for DPCP - it is highly dependent on each patient.
15. My baby/grandchild loves to touch my scalp and hair. Is it okay to play with them after DPCP?
No, it's not. Nobody should come into contact with the DPCP chemical, especially a young infant. You must make sure no such contact occurs, or avoid playing with the child or not use DPCP as your method of treatment. DPCP must be taken seriously. It can be very safe and very effective - but only when respected.
16. I have a cold this week. Should I do my DPCP?
Generally speaking, continuing DPCP is fine. If you have a fever, then hold off for this week and restart the following week. For a more complete answer, please email the office with a more complete summary of how your are feeling and when you became sick, so that we can give you a better answer.
17. I am going on vacation next week. Is it okay to miss my DPCP?
Missing one week every 3 months is generally okay. Missing more than this may jeopardize your chances of success with DPCP treatments.
18. I am using DPCP and getting bubbles on my head. When I scratch them I pop them and they leave a clear liquid. Is this okay. Should I keep going up on the dose?
You'll want to review all the details with Dr. Donovan but certainly you should not increase the dose. For anyone getting DPCP, it is important to remember that all we want is some itching and burning that lasts a day or two. We try not to get the "water bubbles" (ie. these are actually blisters) but this is the body’s way of telling you not to go up to a higher dose yet. Anyone getting DPCP in our program is encouraged to check in with us if anything unusual happens or you're not sure where to proceed next!
19. I am on 0.05 % DPCP and I've been itchy for the last 10 weeks. I even have swollen lymph nodes. I'm worried that I should be going up on the dose because this current dose is too low. Should I be going up to 0.1 % or just stay on the same dose?
You'll want to review all the details with Dr. Donovan but certainly you should not increase the dose. For anyone getting DPCP, it is important to remember that all we want is some itching and burning that lasts a day or two. If you are getting itching, that is excellent and means that you should NOT be increasing the dose. It is important not to focus on the actual dose of the medication but rather if your body is reacting to it or not. Because your body is showing good reaction to the 0.05 % dose, that's all that matters. You should not increase.
