Commentimplications for clinical practice

Diphencyprone is not licensed in the USA. Immunotherapy for alopecia areata is only available in specialist treatment centres. We found no RCTs on the use of topical immunotherapy; however, a number of studies have demonstrated unilateral hair regrowth after unilateral treatment. This protocol conforms to the published investigational guidelines for alopecia areata.14 In almost all case series, patients with limited disease have higher response rates than patients with alopecia totalis/ universalis. In contrast to other studies, Shapiro et al.22 found that a long duration of disease did not necessarily preclude a positive response to treatment with diphencyprone. Tosti et al. concluded from their work that transferring non-responder patients with alopecia totalis or universalis to other therapies is generally useless.23

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