Hitaka Taiyo, Haruyama Sanehito, Ohmori Shun, Saito-Sasaki Natsuko, Okada Etsuko, Nakamura Motonobu, Sawada Yu
Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan.
Haruyama Dermatology Clinic, Gyota City, Japan.
Front Med (Lausanne). 2025 Jul 25;12:1573929. doi: 10.3389/fmed.2025.1573929. eCollection 2025.
Alopecia areata (AA) is a chronic immune-mediated disorder causing non-scarring hair loss. Severe forms like alopecia totalis (AT) and alopecia universalis (AU) pose therapeutic difficult situations. Topical immunotherapy with squaric acid dibutylester (SADBE) and diphenylcyclopropenone (DPCP) is widely used but has variable efficacy.
To evaluate the efficacy of topical immunotherapy in severe AA, identify factors influencing outcomes, and assess adjunctive antihistamine therapy.
A retrospective analysis of 106 severe AA cases (26 AT, 80 AU) among 1,098 patients diagnosed between 2007 and 2016. Treatment efficacy was assessed using the Alopecia Areata Investigational Assessment Guidelines (AAIAG), and statistical analyses included chi-square tests and Kaplan-Meier analysis.
Among the 106 patients included in this study, 43% exhibited excellent or good responses to topical immunotherapy, while 75% experienced at least partial hair regrowth. Patients with alopecia totalis demonstrated slightly better outcomes than those with alopecia universalis (50% vs. 40% achieving excellent or good responses). Atopic dermatitis was significantly associated with lower treatment efficacy (54% vs. 80%, = 0.0157). Although antihistamine use showed a trend toward improved responses (78% vs. 38%), the difference did not reach statistical significance ( = 0.0991), and multivariate analysis did not confirm its efficacy ( = 0.649). Hair regrowth was observed within 4 months in 90% of cases, while peak therapeutic effects were achieved within 3 years. Long-term treatment adherence correlated with improved outcomes, highlighting the importance of sustained therapy.
Topical immunotherapy remains an effective treatment for severe alopecia areata, although response rates vary among patients. Individualized treatment approaches, including prolonged therapy and consideration of patient-specific factors, are essential for optimizing clinical outcomes.
斑秃（AA）是一种慢性免疫介导性疾病，可导致非瘢痕性脱发。全秃（AT）和普秃（AU）等严重形式会带来治疗难题。用二丁基酒石酸（SADBE）和二苯基环丙烯酮（DPCP）进行局部免疫疗法被广泛应用，但疗效不一。
评估局部免疫疗法对重度斑秃的疗效，确定影响治疗结果的因素，并评估辅助性抗组胺药治疗效果。
对2007年至2016年诊断的1098例患者中的106例重度斑秃病例（26例全秃，80例普秃）进行回顾性分析。使用斑秃研究评估指南（AAIAG）评估治疗效果，统计分析包括卡方检验和Kaplan-Meier分析。
在本研究纳入的106例患者中，43%对局部免疫疗法表现出优或良的反应，而75%至少有部分毛发再生。全秃患者的治疗结果略优于普秃患者（优或良反应的比例分别为50%和40%）。特应性皮炎与较低的治疗效果显著相关（54%对80%，P = 0.0157）。虽然使用抗组胺药显示出反应改善的趋势（78%对38%），但差异未达到统计学意义（P = 0.0991），多变量分析也未证实其疗效（P = 0.649）。90%的病例在4个月内观察到毛发再生，而在3年内达到最佳治疗效果。长期治疗依从性与改善的结果相关，突出了持续治疗的重要性。
局部免疫疗法仍然是重度斑秃的有效治疗方法，尽管患者的反应率有所不同。个性化的治疗方法，包括延长治疗时间和考虑患者特定因素，对于优化临床结果至关重要。
