Dermatology-IRCCS, Policlinico Sant'Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy.
Dermatol Ther. 2021 Sep;34(5):e15096. doi: 10.1111/dth.15096. Epub 2021 Sep 3.
Topical immunotherapy is widely used in the treatment of alopecia areata (AA). Alopecia areata incognita (AAI) is a relatively common disorder, predominantly affecting females, characterized by widespread hair thinning in the absence of typical alopecic patches. AAI can have a chronic relapsing course and in some cases can be resistant to current standard treatments. Topical immunotherapy has been used in the management of AA with encouraging results, but to date there are no literature studies reporting the efficacy of topical immunotherapy with squaric acid dibutylester (SADBE) in AAI. The aim of our study is to evaluate the efficacy and tolerance of topical immunotherapy with SADBE in AAI not responding to conventional steroid therapy. A total of 12 patients were enrolled in our Hair Disease Outpatient Service, with a proved histological diagnosis of AAI, and resistant to classical steroid therapy. Each patient underwent global photography, pull test, and trichoscopy at beginning and during the follow-ups. The efficacy of topical immunotherapy with SADBE was assessed by evaluating the changes of clinical and trichoscopic signs. Complete regrowth was achieved in 66.7% of cases (8/12), three patients remained unchanged on clinical evaluation but showed subclinical improvement on trichoscopy, whereas one patient progressed and worsened both on clinical and trichoscopic examination. All patients reported scalp diffuse mild erythema and itching the day after the application of SADBE, which were well tolerated. Three patients developed reactive cervical lymphoadenomegaly. No other side effects were observed. Topical immunotherapy with SADBE is widely used in the management of patchy AA and can be considered an effective alternative in resistant AAI, providing visible clinical and trichoscopic improvement in the majority of cases. Further studies are warranted to confirm and validate our findings.
局部免疫疗法广泛应用于治疗斑秃（AA）。隐匿性斑秃（AAI）是一种较为常见的疾病，主要影响女性，其特征是在没有典型脱发斑块的情况下广泛出现头发稀疏。AAI 可呈慢性复发性病程，在某些情况下可能对当前的标准治疗方法产生抵抗。局部免疫疗法已被用于 AA 的治疗，并取得了令人鼓舞的效果，但迄今为止，尚无文献报道使用 Squaric acid dibutylester（SADBE）进行局部免疫疗法治疗 AAI 的疗效。我们的研究旨在评估 SADBE 局部免疫疗法对常规类固醇治疗无效的 AAI 的疗效和耐受性。我们共招募了 12 名在我们的毛发疾病门诊就诊的患者，这些患者的组织学诊断均为 AAI，对经典的类固醇治疗具有抗性。每位患者在开始和随访期间均接受了全身摄影、拔发试验和毛发镜检查。通过评估临床和毛发镜检查的变化来评估 SADBE 局部免疫疗法的疗效。在 12 例患者中，有 66.7%（8/12）完全恢复，3 例患者临床评估无变化，但毛发镜检查显示亚临床改善，1 例患者进展并在临床和毛发镜检查中均恶化。所有患者均报告在应用 SADBE 后第二天头皮出现弥漫性轻度红斑和瘙痒，但均能耐受。有 3 例患者出现反应性颈淋巴结肿大。未观察到其他不良反应。SADBE 局部免疫疗法广泛用于治疗斑片状 AA，可被视为抵抗性 AAI 的有效替代方法，在大多数情况下可提供明显的临床和毛发镜检查改善。需要进一步的研究来证实和验证我们的发现。
