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immunotherapy with
diphenylcyclopropenone (DPCP) and
anthralin is considered the treatment option for extensive
alopecia areata (AA) unresponsive to DPCP
immunotherapy alone. Only one study has described the efficacy of combination
therapy; therefore, we investigated whether topical DPCP and
anthralin can promote hair regrowth in DPCP-non responders. In this retrospective case-series we analyzed the efficacy and side effects of DPCP with
anthralin in AA patients who did not respond to several months of treatment with DPCP alone. Thirty-two DPCP-nonresponsive AA patients were treated with DPCP and
anthralin for the average of 8.3 ± 3.8 (3-17) months. During the treatment, 40.62% of patients (13 patients out of 32) had terminal hair regrowth. The mean of hair regrowth rate was 41%; it was mainly as partial hair regrowth (˂ 50%) and 27.27% of cases achieved > 50% terminal hair regrowth. Treatment response strongly related to the duration of combination
therapy (p value ˂ 0.001), but we did not find any relation with other demographic characteristics. The first signs of response to treatment were noticed 2-12 months (5.5 ± 3.4) after initiation of combination
therapy while there was a positive correlation among the
duration of treatment and percentage of hair regrowth (p < 0.001). The most common complication was
bullae (25%), and the least frequent side effect was generalized
pruritus (3.1%). The combination
therapy with DPCP and
anthralin could be effective to treat DPCP non-responder AA patients. Additionally, the higher treatment response could be achieved by longer
treatment duration.