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Author: Dr Chin-Yun Lin, Dermatology Registrar, and Dr.Monisha Gupta, MD, FACD, Dermatologist, Sydney, Australia, 2012.

Diphenylcyclopropenone — codes and concepts

What is diphenylcyclopropenone?

Diphenylcyclopropenone (DPCP), also known as diphencyprone, is an experimental sensitising agent used by somedermatologycentres to treat skin conditions by contact immunotherapy.Diphenylcyclopropenoneis most often used to treatalopeciaareata.

Diphenylcyclopropenone is made up in acetone. It should be stored in a dark glass bottle in a cupboard away from sunlight and kept secure from access by children. The compounded preparation has a shelf-life of around 6 months.

How does diphenylcyclopropenone work?

Application of diphenylcyclopropenone to the skin results inallergic contactdermatitis. Inalopecia areata, it is believed to work by redirecting theautoimmuneattacks on thehairfollicles, allowing for re-growth

How to use diphenylcyclopropenone

Initialsensitisationto diphenylcyclopropenone is required for the treatment to work. The clinician applies a small testpatchof high-concentrationdiphenylcyclopropenone (2%) and left in place for 2–3 days to inducecontactallergy.

The patient or assistant then applies a weaker concentration of diphenylcyclopropenone to the affected areas once weekly, using up to 1 ml per session. Thesolutionshould remain on the skin for 6–24 hours or as directed and is then washed off. The area of application should be physically covered during the first 24 hours, as diphenylcyclopropenone is degraded by sunlight.

Great care should be taken to avoid diphenylcyclopropenone touching other areas of the body. Gloves should be worn by the patient and/or assistant for each application. There is a risk that the patient's partner or health care worker may also become sensitised anddevelopdermatitis.

What to expect with diphenylcyclopropenone treatment? What are the side effects?

As diphenylcyclopropenone causes contact allergy, localdermatitisis an expected part of treatment. A mild reaction with redness and itching is desirable and usually lasts for 24–48 hours.

Some patients may experience severe itching, burning, blistering or swelling of treated areas. As diphenylcyclopropenone is most often applied to the scalp, the reaction may make wearing wigs or headwear uncomfortable. Swollenlymphnodesmay be noticeable behind the ears.

These side effects generally clear up promptly when treatment is stopped.

After initial sensitisation, a very low diphenylcyclopropenone concentration is often chosen to reduce the severity of dermatitis, for example, 0.001%. The strength is gradually increased over time, for example, 0.01%, 0.1%, 0.2%, 0.5%, 1% and 2%.

Other side effects may include:

What is the treatment for diphenylcyclopropenone-induced dermatitis?

Severe contact reactions and blistering may be treated with potenttopicalsteroids, cool compresses, and if necessary, a short course oforalcorticosteroids(eg, prednisone).

What success rates are reported with diphenylcyclopropenone?

In a retrospective study involving 54 patients with alopecia areata,terminal hairregrowth on the scalp was excellent (76–100%) in 40.7%, good (51–75%) in 14.8%, moderate (26–50%) in 14.8% and mild (< 25%) in 29.6% of patients. The overall response rate in that study was 55%.

Diphenylcyclopropenone is not effective for everyone. A response is more likely in those who have had alopecia areata for less than 10 years and have limited hair loss atbaseline. Poorer outcomes are reported if the extent of the hair loss is 50% or greater, in patients who also haveatopicdermatitis, and who havenailinvolvement.

It is recommended that treatment should be continued for 6 months before declaring treatment failure.

Diphenylcyclopropenone treatment is usually continued weekly until the hair is re-grown, which may take up to 12 months. Treatment is stopped upon hair regrowth and patients are monitored forrelapse. Relapse with further hair loss is common, with one study reporting a rate of 33%, and another study 68.9%. However, most patients benefit from another course of treatment.

diphenylcycloprope安全none in children and during pregnancy

Two studies of contact immunotherapy in children with alopecia areata reported response rates of 33% and 32%.

There are no data on the safety of contact immunotherapy during pregnancy and it should not be used in pregnant women nor in women intending to become pregnant.

There are safety concerns about diphenylcyclopropenone. Although diphenylcyclopropenone is non-mutagenic in the Ames test, its precursor and possible contaminant during commercial production, α,α'-dibromodibenzyl ketone, can be mutagenic.

Other indications for diphenylcyclopropenone

Diphenylcyclopropenone may be useful in treatingrecalcitrantviral warts. One centre in Melbourne, Australia, reported an 88% success rate in clearingpalmoplantarwarts with 0.1%diphenylcyclopropenoneand 15% salicylic acid in white soft paraffin. The salicylic acid reduced thickscalebuild-up over warts, thus allowing improved absorption of thediphenylcyclopropenone.

Diphenylcyclopropenone has also been used to treat extensive or locally advancedcutaneousmelanomametastasesthat are unsuitable for other therapies. A recent case series of seven patients treated with diphenylcyclopropenone demonstrated complete responses of cutaneousmetastaticmelanoma in four cases, and three had partial responses. The treatment was well tolerated by all patients. SeeTopical and intralesional immunotherapy for melanoma.

Other topical sensitisers

局部immunotherapy can be undertaken using other sensitising chemicals such as dinitrochlorobenzene (DNCB) or squaric acid. Published data on theefficacyof dinitrochlorobenzene in alopecia areata is currently limited to case reports and small trials, and there is no convincing evidence that it is beneficial in the long term.

Dithranolis anirritantchemical usually used in the treatment ofpsoriasis; it has also been applied to areas of alopecia areata to inducecontact irritant dermatitiswith the hope of stimulating hair to grow. Its efficacy is uncertain.

新西兰的批准为官方数据ource of information for these prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.


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