We found one systematic review of published case series on the use of topical immunotherapy with diphencyprone, which concluded that 50-60% of patients achieve a worthwhile response. Patients with limited disease have higher response rates than patients with alopecia totalis/universalis.14
We found no RCTs. In the largest series reported to date of diphencyprone in the treatment of alopecia areata, 148 consecutive patients were evaluated for unilateral regrowth following unilateral treatment.15 At 32 months, cosmetically significant regrowth was obtained in 17-4% of those with alopecia totalis/universalis, in 60-3% of those with 75-99% hair loss, in 88-1% of those with 50-74% hair loss and in 100% of those with 25-49% hair loss. The only other independent predictor of treatment response was age of onset of alopecia areata, with older age of onset portending a better prognosis.16 Relapse after achievement of cosmetically significant regrowth occurred in 62.6% after 37 months' follow up and was not prevented by maintenance therapy.16
A controlled trial compared SADBE, diphencyprone, minoxidil and placebo in patients with patchy alopecia areata involving less than 40% of the scalp.17 The study involved 119 patients and was continued for at least 6 months. No significant differences were found between the different therapies used and placebo.
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