Dr Anton Alexandroff
Consultant Dermatologist
www.alexandroff.org.uk
Treatment with diphencyprone for alopecia areata
Dermatology Department
Information for Patients
University Hospitals of Leicester
NHS Trust
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Introduction
In this leaflet you will find information about:
(1) What diphencyprone is and what it is used for and how to store it
(2) What happens before treatment with diphencyprone
(3) Precautions to take before each treatment
(4) What happens during treatment with diphencyprone
(5) What to expect after treatment with diphencyprone
(6) Side effects/risks associated with treatment
(7) Treatment duration and success rates
(1) Diphencyprone
Diphencyprone is an unlicensed medication i.e. not licensed in the UK for the treatment of alopecia areata, however it is still safe to use. Although diphencyprone has been used to treat skin for 30 years, this has never been patented. In order to apply for a license a company is required to run an expensive clinical study and to submit the results to the regulatory authority. Because there is no patent this is unlikely to be commercially practical.
Alopecia areata is an auto-immune condition in which the body’s own immune system damages the hair follicles where the hair grows. Diphencyprone is a chemical to which an allergic reaction is common. The plan is to make an allergic skin reaction happen at the area of skin where an immune response is needed.
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(1) Diphencyprone (continued)
Diphencyprone is a highly flammable liquid. All bottles should be stored in a cool place (this may include a fridge) protected from the light, as the diphencyprone can be affected by direct sunlight and to a lesser extent by artificial lights. Diphencyprone should be kept out of reach of children.
(2) Before treatment with Diphencyprone
All patients attend a dermatology clinic where you will meet a dermatology doctor or specialist nurse. At this clinic, we will ask for details of your medical history, medication you take and carry out any necessary clinical examination and investigations which may also include clinical photographs being taken for your records. We will also ask you to sign a consent form if you wish to be treated with diphencyprone and we will give you a treatment record booklet.
On this clinic visit and on any subsequent follow up visits, you will have every opportunity to ask any questions about the treatment and discuss any concerns you may have at any time.
(3) Precautions to take before each treatment
You should not start treatment with diphencyprone if you are pregnant, planning to become pregnant in the next six months or are breast feeding. Any other persons applying the treatment should not be pregnant, planning to become pregnant in the next six months, or breast feeding.
This is because the side effect or effects of diphencyprone have not been studied during pregnancy. Diphencyprone is not known to affect fertility of males or females.
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(3) Precautions to take before each treatment (continued)
• Before treatment your skin should be clean and dry.
• Please inform the nurse or doctor if you have started any new medication.
• You should not sunbathe, swim or use a sun bed for 48 hours after applying diphencyprone. This is in order to avoid exposing diphencyprone treated skin to sun light or risking it being washed off, which can reduce the effectiveness of treatment.
• The treated area should be protected from the sun.
• If you are applying treatment on the scalp then a hat should be worn after the treatment is applied should you go out. The sun’s rays break down the chemical and prevent it working as it should.
• Ideally your hat should be washable so that it can be washed after each time it is worn after treatment as the chemical can remain on the inside of the hat.
• Hair must not be washed for 48 hours after applying the treatment.
• If a wig is worn then you should continue to wear the same wig for 48hrs after treatment. Then wash both the scalp and the wig. Any shampoo can be used.
• A prescription for a strong steroid cream or ointment will be given to you at the time of your first treatment. This is in case you react excessively to the treatment. Excessive reaction may include severe redness, itch, soreness and rarely blisters. If this happens you should apply steroid cream or ointment, you were given, generously once a day until the reaction settles. If the reaction does not settle after few days please contact our dermatology nurse.
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(4) During treatment with diphencyprone
It is extremely important that the diphencyprone solution is only applied when, where and how as directed by the dermatologist or specialist nurse
There are three stages to treatment with diphencyprone.
1. Creating an allergic reaction to diphencyprone.
2. Testing to find a suitable strength of diphencyprone for treatment
3. Treatment with regular painting onto the skin of the correct strength of diphencyprone.
Stage 1
A strong solution of diphencyprone (usually a 2% solution) is painted on to a small area on the arm or scalp. An allergic reaction will often develop after a single application, but if not, a weaker solution (0.1%) is painted on the same site a few weeks later, and then repeated at intervals until a reaction develops.
An allergic reaction will be seen and felt as a red itchy change in the skin
Stage 2
Once the allergy has developed, the next stage is to try to find the correct strength of diphencyprone solution that will give just enough, but not too much, of an allergic reaction. Starting with a very weak solution of diphencyprone a small area of skin is painted. The strength of the solution used is increased every 2 weeks until a moderate allergic reaction is produced. The ideal reaction is pink and a bit itchy for about 36 hours.
DRAFT 6
(4) During treatment with diphencyprone (continued)
Stage 3
Once the strength of diphencyprone solution that produces a moderate allergic reaction has been found, this solution can be applied to the target area of skin as directed. Only one side of the head (usually the right side of the head) is treated at any one time to make sure that any regrowth is from the treatment and is not a spontaneous regrowth. If the treatment is causing the regrowth it will only be on the side where the treatment has been applied.
(5) What to expect after applying the treatment
After applying the diphencyprone should the skin become a bit pink and slightly itchy, this reaction should subside in 36 to 48 hours.
Should the reaction to the diphencyprone be more severe than expected then the skin may become very itchy and even blister.
The steroid cream or ointment prescribed on the first visit maybe applied until the reaction has settled.
Should you run out or lose the steroid treatment you should inform the nurse or doctor so that a new tube maybe prescribed.
Occasionally some people experience swollen glands particularly at the back of the neck which is the result of the inflammation produced by the treatment.
Very occasionally an unusual allergic reaction occurs: this may be associated with light-headedness, tightness in the chest and difficulty breathing. If this happens it is always very soon after the treatment has been administered, therefore after each of the initial sensitizing visits you will be asked to remain in clinic for up to one hour.
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(5) What to expect after applying the treatment (continued)
Allergic reactions of this type, triggered by diphencyprone, are extremely rare but might happen at the begging of the treatment. This is why after each of the initial sensitizing visits you will be asked to remain in clinic for up to one hour.
If you feel lightheaded and/or tightness in the chest and difficulty breathing you should immediately tell a nurse in the Department. You may be given antihistamine and other treatment if required. If this happens diphencyprone should not be used in future.
(6) Significant, unavoidable or frequent occurring risks/ side effects of this treatment
The main side effects are the expected itch and slight discomfort of an allergic skin reaction, allergic dermatitis. If this is quite severe, then the dermatitis can blister, weep and be uncomfortable.
You should always take great care when applying diphencyprone to the skin. Always wear gloves and an apron.
Do not touch your scalp once the solution has been applied; if you do touch your scalp then wash your hands immediately.
Should the solution accidentally drip or be transferred to other areas of skin through touching or rubbing on to other areas (for instance by lying on a pillow) then an allergic dermatitis can happen in these other areas. Take care to avoid the solution coming into contact with other people’s skin. Again the steroid cream or ointment will need to be applied to this area until the skin settles.
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(6) Significant, unavoidable or frequent occurring risks/ side effects of this treatment (continued)
Another side effect that can develop more rarely is widespread nettle rash or urticaria. This is a very itchy, bumpy rash that can occur in about one in ten people who have this treatment. If you experience this type of reaction, stop the treatment and take antihistamine tablets (for example loratadine available over counter). If in doubt please contact our dermatology nurse or your GP.
Hyperpigmentation (increased pigmentation of skin), hypopigmentation (decreased pigmentation of skin) and vitiligo (white marks) are other rarer side effects. If you notice changes in skin colour please stop using diphencyprone straight away and report this to the nurse when you see her next time.
Sometimes during treatment the reaction to any one strength of diphencyprone that is being used can change, giving either a weaker or stronger than expected allergic dermatitis. If the reaction is too strong (causes excessive redness and/or itch and/or blisters and/or being too uncomfortable) please stop treatment and report this to the nurse.
Very occasionally an unusual allergic reaction occurs: this may be associated with light-headedness, tightness in the chest and difficulty breathing. This is discussed above in section (5).
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(7) Treatment duration and success rates
How long will I have treatment with diphencyprone?
The duration of treatment is usually for a minimum of six to eight months. If no response has occurred in that time, it is unlikely to happen with longer treatment.
Will diphencyprone cure my Alopecia areata?
If diphencyprone treatment works, it can stimulate hair to grow again. Of 100 people with alopecia treated with diphencyprone about 30 will have a good regrowth, about 25 will have moderate regrowth, and 45 will have unsatisfactory or almost no regrowth.
If the alopecia areata affects the whole head, the chances of successful treatment are lower with about 20% of people getting good hair growth.
However, alopecia is a very variable disease- sometimes once the hair has re-grown it continues to grow, but in one half to three quarters of people it is lost again in which case maintenance diphencyprone treatment can be given.
The diphencyprone treatment does not ‘turn off’ the body’s own immune system and attacks on the hair follicles may continue for a long time.
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Questions
If you have any questions write them down to remind you what to ask when you speak to your consultant.
Thank you for reading my blog. If you have any questions, please see my website www.alexandroff.org.uk
Dr Anton Alexandroff
Dr Alexandroff is a Consultant NHS and Private Dermatologist with a special interest in skin cancer, acne, dermatitis, psoriasis and hair loss. His NHS practice is based in the University Hospitals of Leicester and he also sees private patients in Leicester Spire and Nuffield Health hospitals.
for more information about alopecia see www.alexandroff.org.uk
