Evaluation of topical immunotherapy with squaric acid dibutylester, systemic interferon alpha and the combination of both in the treatment of chronic severe alopecia areata

Abstract

A total of 30 patients with severe recalcitrant alopecia areata were randomly assigned to one of three groups. One group was treated with topical immunotherapy (TI) with squaric acid dibutylester at weekly intervals, for a maximum of 32 weeks, the second group was treated with lymphoblastoid interferon (IFN) alpha given by the intramuscular route for a 3-month period, and the third group received a combination of both treatments. After discontinuation of therapy the patients were followed-up at 4-week intervals for a 6-month period. At the end of this period, clinical responses were assessed according to the following four-point scale: 3 = full and stable recovery with a 6-month relapse-free period; 2 = full recovery with relapse occurring within 6 months; 1 = partial recovery; 0 = no response or disease progression. Combination (TI + IFN) therapy patients had significantly (P = 0.02) higher cure rates. In this group, scores of 3 and 2 were given to three and two patients, respectively. By contrast, in both monotherapy groups no score 3 was assigned, and only two patients were assessed as score 2. This study provides some support for the hypothesis that the association of TI and systemic IFNs are more effective than either treatment alone. The possibility of a synergistic action is discussed.