{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:23:30Z","timestamp":1787772210338,"version":"build-2784847793"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Alopecia totalis (AT) and Alopecia universalis (AU) are forms of Alopecia areata (AA) which represent the strongest predictor of poor prognosis since spontaneous regrowth is &lt;10%. Topical immunotherapy agent, diphenylcyclopropenone (DPCP) has shown clinical efficacy with limited side effects in severe forms of AA. However, its specific role in AT\/AU characterized by complete hair loss over the scalp can help highlight the efficacy of the drug with fewer confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology:<\/jats:title>\n                    <jats:p>\n                      Data were collected from 18 patients diagnosed with AT\/AU and treated with topical immunotherapy with DPCP as per protocol by Happle\n                      <jats:italic toggle=\"yes\">et al<\/jats:italic>\n                      . Baseline Severity of Alopecia Tool (SALT) score and subclass was recorded. In the case of AU, baseline body hair loss score was also recorded. Patients were reassessed after 6 months of treatment in terms of change in SALT score and hair regrowth was assessed using the Global Assessment Score. The side effects during treatment were also assessed and recorded.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Eighteen patients of whom eleven (61.1%) were diagnosed as AU and seven (38.9%) as AT were treated. The mean age was 21.6, with a male: female ratio of 3:2. The comorbidities noted were atopy in six (33.3%), atopy and hypothyroidism in one (5.5%), Down\u2019s syndrome in two (11.1%), and hypothyroidism alone in one (5.5%) patient. The mean duration of disease at the time of presentation was 3 years and all patients had remained refractory to various other modalities of treatment. All patients had a baseline SALT score of 100 corresponding to S5. After 6 months of treatment, 27.7% of patients did not show any response (SALT score S5), 16.6% had a score of S4, 11.1% had a score of S3, 11.1% had a score of S2, 22.2% had a score of S1, and 11.1% had a score of S0. On assessing improvement in body hair loss score, 36.3% of patients showed no improvement, 36.3% showed partial improvement, and 27.2% of patients showed complete body hair regrowth. About 55.5% of patients developed notable side effects that included severe local reactions, cervical lymphadenopathy, acne and pigmentation at the site of application as well as untreated sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The AT\/AU subtypes of AA, was amenable to treatment with contact immunotherapeutic agent DPCP with a &gt;75% hair regrowth in 33.3% of patients. The castling phenomenon was seen in 63.6% of AU patients. The adverse effects noted were not severe enough to deter treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijt.ijt_2_22","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T06:00:09Z","timestamp":1712901609000},"page":"149-153","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Treatment Response to Diphenylcyclopropenone in Patients with Alopecia Totalis\/Universalis"],"prefix":"10.4103","volume":"15","author":[{"given":"Smitha Ancy","family":"Varghese","sequence":"first","affiliation":[{"name":"Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandhya S.","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuja Elizabeth","family":"George","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Induprabha","family":"Yadev","sequence":"additional","affiliation":[{"name":"Department of Surgery, Government Medical College, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"R1-20240903","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.jaad.2019.08.032","article-title":"Epidemiology of alopecia areata, ophiasis, totalis, and universalis: A systematic review and meta-analysis","volume":"82","author":"Lee","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"R2-20240903","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4103\/ijt.ijt_99_17","article-title":"Alopecia areata: Review of epidemiology, clinical features, pathogenesis, and new treatment options","volume":"10","author":"Darwin","year":"2018","journal-title":"Int J Trichology"},{"key":"R3-20240903","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jaad.2006.05.008","article-title":"Alopecia areata: A long term follow-up study of 191 patients","volume":"55","author":"Tosti","year":"2006","journal-title":"J Am Acad Dermatol"},{"key":"R4-20240903","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1136\/bmj.331.7522.951","article-title":"The psychological impact of alopecia","volume":"331","author":"Hunt","year":"2005","journal-title":"BMJ"},{"key":"R5-20240903","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1080\/14656566.2020.1854728","article-title":"Are drug treatment strategies really effective against alopecia areata?","volume":"22","author":"Rattananukrom","year":"2020","journal-title":"Expert Opin Pharmacother"},{"key":"R6-20240903","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1111\/ijd.13612","article-title":"Review of treatment for alopecia totalis and alopecia universalis","volume":"56","author":"Kassira","year":"2017","journal-title":"Int J Dermatol"},{"key":"R7-20240903","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1111\/j.1468-3083.2011.04114.x","article-title":"Topical immunotherapy with diphenylcyclopropenone of patients with alopecia areata \u2013 A large retrospective study on 142 patients with a self-controlled design","volume":"26","author":"Ohlmeier","year":"2012","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"R8-20240903","doi-asserted-by":"crossref","first-page":"36","DOI":"10.4103\/0974-7753.66911","article-title":"Topical immunotherapy in alopecia areata","volume":"2","author":"Singh","year":"2010","journal-title":"Int J Trichology"},{"key":"R9-20240903","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.jaad.2003.09.032","article-title":"Alopecia areata investigational assessment guidelines - Part II. 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