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Alopecia Areata — SCE Dermatology MCQ

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ModerateHair DisordersAlopecia AreataSCE Dermatology

A 40-year-old woman with alopecia areata has been treated with topical DPCP immunotherapy for 6 months. She has developed allergic contact dermatitis at the treatment site as expected, but hair regrowth has been minimal. Before abandoning DPCP, what is the maximum treatment duration typically recommended before declaring failure?

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Correct answer: A — 12-24 months (response can be slow; treatment should continue for at least 12 months before concluding failure)

DPCP (diphenylcyclopropenone) topical immunotherapy for alopecia areata typically requires 12-24 months of treatment before concluding failure. Response can be slow — some patients show initial regrowth only after 9-12 months. The contact dermatitis at the treatment site is the desired pharmacological effect (mild eczematous reaction indicating adequate sensitisation). Concentration should be titrated to maintain mild erythema/eczema. Success rates range from 40-60% for extensive AA. DPCP should be applied by trained dermatology staff in dedicated facilities (it is a potent sensitiser). If no response after 24 months, alternative therapies (JAK inhibitors) should be considered.

Reference: BAD 2012 Alopecia Areata Guidelines