Squaric acid, DPCP and Steroid Injections: Can then be used together?

Squaric acid, DPCP and Steroid Injections for Alopecia areata

Alopecia areata is an autoimmune hair loss condition. Patients often develop circular or oval shaped patches of hair loss first. However, some patients go on to develop more widespread hair loss while others regrow their hair back.

There are at least 25 treatment options for alopecia areata that a dermatologist can offer. One generally starts with the safest options before moving down the list of potential treatments.


Squaric acid, DPCP and Steroid injections

Alopecia areata is understood to be an autoimmune disease. What this means is that the body’s immune system is somehow primed to attack the hair. (It’s probalby also true to say that the body’s hair follicles are also ‘primed’ to call the immune system over to it as well).

When a biopsy is performed from the scalp of a patient with alopecia areata, what is generally seen are inflammatory cells called lymphocytes around the base of hairs. In this inflammatory soup, hair follicles simply can’t grow well and leave the scalp. Treatments that reduce a specific type of inflammation called lymphocytic inflammation are helpful for many patients with alopecia areata. These treatments include topical steroids, steroid injections, as well as a wide variety of immunosuppressive pills. Topical steroids and steroid injections are generally considered first line in the treatment of localized alopecia areata (i.e. alopecia areata confined to a few patches).

Squaric acid dibutyl ester (SADBE) and diphencyprone (DPCP) are unique weekly topical scalp treatments that do not directly reduce inflammation but rather redirect where in the scalp the inflammation ends up and also the specific type of inflammation that gets created. The same is true with anthralin, although anthralin causes ‘irritation’ rather than true allergy. When SADBE or DPCP are applied to the scalp, an allergic reaction develops on the scalp and this directs the immune system focus away from the hair follcile and towards the scalp skin instead. When anthralin is applied to the scalp, an irritant reaction develops on the scalp and this directs the immune system focus away from the hair follcile and towards the scalp skin instead.

Can Squaric acid or DPCP be used with Steroid Injection Treatments?

Even though squaric acid, DPCP and steroid injections are three important treatments for alopecia areata, the they can not be used together. The treatments work completely opposite each other. Squaric acid or DPCP activates inflammation and causes redness, scale and dermatitis. Steroid injections stop inflammation and remove redness, scale and dermatitis. The treatments essentially cancel each other if used too close together. The same is true with anthralin - anthralin and steroid injections don’t generally go together.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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