Can the Cytokine Analysis of the Scales on Alopecic Patch Predict the Response to Diphenylcyclopropenone Treatment in Alopecia Areata Patients?

BACKGROUND: Contact immune modulating therapy with diphenylcyclopropenone (DPCP) is a topical treatment option for extensive alopecia areata (AA). Because the response to DPCP treatment varies according to the patient, and it takes several months to evaluate the clinical effectiveness of the treatment, it is necessary to identify the factors that can predict the prognosis of the disease while treating with topical DPCP. OBJECTIVE: In this study, cytokine levels in the scales of alopecic patches were investigated to identify whether they could predict response to DPCP during the early treatment period. METHODS: Scale samples were taken from the alopecic patches in eight AA patients at 1 week, 2 months, and 4 months after DPCP sensitization. The patients were divided into responders and non-responders according to the clinical responses of DPCP treatment. Interferon (IFN)-gamma, interleukin (IL)-2, IL-12 and IL-10 levels of the subjects were compared in several perspectives. RESULTS: Cytokine levels after 1 week of DPCP sensitization showed no statistically significant difference between two groups. After 4 months of treatment, IFN-gamma levels were significantly lower in responders than in non-responders. CONCLUSION: The results of this study show IFN-gamma levels in the scales of alopecic patches might possibly reflect the clinical response in AA patients treated with DPCP. However, initial cytokine levels could not predict the treatment response.

Topical Immunotherapy with Diphenylcyclopropenone Is Effective and Preferred in the Treatment of Periungual Warts

BACKGROUND: There exists a treatment challenge with periungual warts. Topical immunotherapy with diphenylcyclopropenone (DPCP) has recently been reported to be an effective treatment for recalcitrant warts, including periungual types. OBJECTIVE: We aimed to evaluate the effectiveness and preference of topical immunotherapy with DPCP in treating periungual warts. METHODS: Twenty-seven patients with periungual warts who were treated with DPCP immunotherapy (2007 through 2010; Dongguk University Ilsan Hospital, Goyang, Korea) were retrospectively recruited. Other treatment modalities were also used in some patients. Lesions were grouped into the types according to the following locations: proximal nail fold, lateral nail fold and hyponychium. Total and group clearance rates as well as treatment periods according to location and disease duration were evaluated. A patient questionnaire was performed to assess the satisfaction for the treatments in those who received multiple therapies. RESULTS: Total success rates were 85% (by subjects) and 91% (by individual lesions). Success rate and treatment period for proximal nail fold type seemed more desirable than other locations. Success rate decreased and treatment period increased as disease duration increased. The questionnaire revealed a significantly higher satisfaction rate for DPCP immunotherapy than for cryotherapy and pulsed-dye laser. CONCLUSION: Topical immunotherapy with DPCP is an effective and preferred method in the treatment of periungual warts.

Proper Concentration of Diphenylcyclopropenone Solution according to the Anatomical Location and Application Time Interval for the Treatment of Warts / 대한피부과학회지

BACKGROUND: Topical diphenylcyclopropenone (DPCP) application on a daily or weekly basis has been used for the treatment of warts that affect different sites of the body. The concentration of DPCP for the treatment of warts needs to be determined according to the body site. In addition, the therapeutic response to DPCP application intervals needs to be evaluated for the treatment of warts. OBJECTIVE: The purpose of this study was to determine the minimal DPCP concentration required to induce an elicitation reaction in different body sites of patients with warts and to assess the therapeutic response of wart treatment with daily and weekly applications of DPCP. METHODS: Thirty patients with warts were divided into two groups. Each patient in the two groups was sensitized with 0.1% or 0.2% DPCP. After sensitization, in the first group of patients, DPCP was applied to warts daily. In the second group of patients, DPCP was applied to warts weekly. The initial concentration of DPCP was 0.01% for warts located on the palmoplantar area, periungual area and the dorsum of the hand, knee and upper arm. The initial concentration of DPCP was 0.004% for warts on the face. If no reaction was observed, the DPCP concentration (0.01%, 0.025%, 0.05%, 0.1%, 0.25%, 0.5%, 1% and 2%) was increased stepwise. The minimal concentration of DPCP to induce an elicitation reaction and treatment results were evaluated. RESULTS: The minimal concentrations of DPCP to induce an elicitation reaction were as follows: 0.004~0.01% for the face, 0.01~0.025% for the dorsum of the hand, 0.25~1% for the periungual area and 0.5~2% for the palmoplantar area. The results of weekly application of DPCP were similar as compared to the daily application of DPCP for the treatment of warts. CONCLUSION: Although further studies are needed, our study suggests that the DPCP concentration needs to be adjusted according to the body site and that the weekly use of DPCP may be a convenient alternative to daily use to treat warts.

Two Cases of Alopecia Totalis treated with Diphenylcyclopropenone (DPCP) Immunotherapy / 영남의대학술지

Treatments for alopecia areata include topical corticosteroid treatment, corticosteroid intralesional injection, systemic corticosteroid treatment, PUVA(psoralen-UVA) and topical immunotherapy. The therapeutic effects are variable. Alopecia totalis is hard to treat completely. Topical immunotherapy with dinitrochlorobenzene (DNCB), squaric acid dibutyl ester (SADBE) or diphenylcyclopropenone (diphencyprone, DPCP) represents the most accepted therapeutic modality for the treatment of extensive alopecia areata. We report two cases of alopecia totalis treated with DPCP. After DPCP treatment, total scalp hair was completely recovered.

The Clinical Effect of Topical Diphenylcyclopropenone (DPCP) Therapy in the Treatment of Atopic Dermatitis in Children and Adolescents / 대한피부과학회지

BACKGROUND: Atopic dermatitis is the most common chronic skin disease in childhood. Severe atopic dermatitis may require use of topical or systemic corticosteroids. These treatments are prone to several adverse side effects. This paper highlights the impressive effect of diphenylcycloprope none(DPCP) sensitization in some cases of childhood and adolescent atopic dermatitis. OBJECTIVE: The purpose of this study was to examine the effect of DPCP in treating severe atopic dermatitis of children and adolescents. METHODS: Twenty eight patients, who had moderate to severe atopic dermatitis, were recruited in the treatment of DPCP weekly for 10 weeks and followed up for another 4 weeks. Severity of atopic dermatitis was measured using SCORAD index. RESULTS: Sixteen of 28 patients had finished the treatment courses. After 10 weeks of therapy with DPCP, the patient's symptoms were improved and the mean SCORAD index was significantly reduced from 48.9+/-17.8 to 18.0+/-9.1 (p<0.01). During the follow-up period, patients could be managed by topical steroid and oral antihistamine and flare-up was not observed. CONCLUSION: According to our study, DPCP can be an effective, safe and well-tolerated therapy for moderate to severe atopic dermatitis in children and adolescents. We suggest that DPCP may be effective in the treatment of moderate to severe atopic dermatitis of children and adolescents without serious complications.

A Case of Vitiligo Induced by Diphenylcyclopropenone in a Patient with Malignant Melanoma / 대한피부과학회지

DPCP(diphencyclopropenone) has been used for the treatment of alopecia areata or verruca. Common side effects due to topical treatment with DPCP are pruritus, blistering, cervical lymphadenopathy and urticaria. Rarely, vitiligo can be induced by topical treatment with DPCP as a complication on the pigmentary system. Herein we report a case of vitiligo induced by DPCP in a patient with malignant melanoma. She was diagnosed with malignant melanoma in her 4th toe, Rt., a year ago. As part of adjuvant therapy, DPCP was topically applied to the inguinal area every week. After 4 months, vitiligo appeared on the area of DPCP application.

Disappearing Atypical Lentiginous Pigmentation of the Desmoplastic Malignant Melanoma

A 38-year-old man presented with a black pigmented patch overlying his upper lip, a part of the gingiva and the hard palate. An intradermal tumor mass was palpated at the central portion of the pigmented patch of the upper lip. Diphenylcyclopropenone (DPCP) is a potent contact sensitizer that could stimulate non-specific immunity. We report a case of desmoplastic malignant melanoma (DMM) in which an atypical lentiginous pigmentation disappeared with topical DPCP immunotherapy and the dermal tumor mass was removed by a surgical wedge-shaped excision. Though an atypical lentiginous pigmentation of DMM sometimes undergoes extensive spontaneous regression, in our case it could be attributed to the therapeutic effect of topical DPCP immunotherapy rather than a spontaneous regression.

Condyloma Acuminata Treated with Combination Therapy of Electrodessication and Applying Trichloroacetic Acid

There are many methods to treat condyloma acuminata (CA) such as physical destruction or immunotherapy, but they are not always satisfactory, especially when the lesions occur in young children or infants. Two patients, who showed CA on their anal region, were treated by combination therapy of ED and applying TCA, and were evaluated on the efficacy of the therapeutic method. Clinically and pathologically proven CA was treated with a simple combination method. First, the wart lesions were carefully electrodessicated and swept away, After that, 30% trichloroacetic acid was applied to eroded area. Clinical examination was performed periodically after treatment. Elimination of the CA was successful by one procedure. Complication was not found after treatment.There was no recurrence 1 year later at least. The combination therapy of ED and applying TCA seems to be a very simple, convenient and effective method.

Erythema Multiforme due to Topical Application of Diphenylcyclopropenone(DPCP) / 대한피부과학회지

We report a case of erythema multiforme following topical application of diphenylcyclopropenone (DPCP), which occurred during the artificial induction of contact dermatitis in one of two volunteer patients of the objective structured clinical examination(OSCE). The characteristic polycyclic erythematous target-like lesions developed on both hands and forearms after fourth sensitization with 0.1% DPCP in a period of a week because of lack of response. In spite of systemic and topical corticosteroid treatment, the skin lesions lasted one month accompanied with dermographic urticaria. A minimal dose of DPCP can be used for initial sensitization to reduce the risk of a severe generalized eruption like erythema multiforme, although allergic reaction is less likely to be dose-dependent.

Comparative Studies in the Therapeutic Effects between DNCB and DPCP in the Verruca Plana / 대한피부과학회지

This stuc1y was conducted to evaluate the therapeutic effect of immunotherapy on verruca plana. Forty-four patients with verruca plana were tried with dinitrochlorobenzene(DNCB) and diphenylcyclopropenone(DPCP) by topical application on the norinal uninvolved skin of the inner arms for sensitization and challenge. The lesions were challenged in weekly intervals after sensitization. The results obtained in this study are as follows. 1. Mean age of our patients was 20-year-old and sex ratio was about 1:2 (14 of male, 30 of female). 2. Tbe sites of the lesion weve face (60.9%), neck (7.2%), trunk (2.9%), arm (li3.0%), hand (11.6% ), leg (4.3% ). 3. Thirty two patients (72.7%) from 44 cases were completely cured after DNCB (81.3%) and DPCP (67%) treatment and iesions on younger patients showed a better response than those of of older patients(p<0.05). 4. There were no statistic relationship between duration of the lesions and therapeutic response. 5. Average challenge number after sensitization was 3.77 in DNCB, 2.26 in DPCP, respectively. 6. Sensitization rates in the cured patients were to treat verruca plana 94.7% (18/19) in DNCB, 76.9% (10/13) in DPCP, respectively.

Erythema Multiforme due to Diphenylcyclopropenone

A 34-year-old man visited our hospital with alopecia areata on the occipital scalp, which began to develop two months prior to his visit. He was sensitized with 0.2% diphenylcyclopropenone(DPCP) in acetone that was applied to the inner side of his right arm. Two weeks after sensitization, we applied DPCP on his bald lesion once weekly for skin challenge. Following the third application of DPCP, polycyclic erythematous target-like lesions developed around the sensitized area. A clinical diagnosis of erythema multiforme was made. Histologically, the target-like lesion showed few eosinophilic dyskeratosis, exocytosis, and hydropic de-generation of basal layer in the epidermis, and mononuclear infiltration around superficial blood vessels in the dermis. We report herein a rare case of erythema multiforme following topical application of DPCP in the treatment of alopecia areata. This complication must be noted because of the wide-spread and frequent use of DPCP in dermatotherapeutic fields.

Two Cases of HPV 16 - positive Bowenoid Papulosis Treated with Diphenylcyclopropenone Immunotherapy / 대한피부과학회지

Bowenoid papulosis(BP) is characterized by multiple papules with a benign clinical course but having a histopathology of squamous cell carcinoma in situ on the external genitalia of sexually active men and women. It is well known that the Human papilloma virus(HPV) is connected with the development of BP. Out of these, HPV 16 which has been frequently found in the BP lesions is an oncogenic virus and the theory that BP might progress to intraepithelial neoplasia and advanced carcinoma has been postulated. Local destructive therapy including electrodessication, laser surgery, cryosurgery, and surgical excision is effective and produces a low recurrence rate. However, pain, bleeding, restriction in activity, and postoperative scars are inevitable with complete destruction of the multiple lesions. It has been suggested that diphenylcyclopropenone(DCP) might be a promising therapeutic agent for various viral diseases including HPV-related warts, It is a potent sensitizer which is not mutagenic and works by the induction of type IV hypersensitivity response in HPV infected tissue, leading to wart destruction. We herein, report 2 cases of HPV 16-positive BP treated with DCP immunotherapy.

The Effect of Diphenylcyclopropenone Immunotherapy on Molluscum Contagiosum

BACKGROUND: Contact immunotherapy using diphenylcyclopropenone (DPCP) has been used in the treatment of alopecia and warts. DPCP seemed to be a promising agent for viral disease including molluscum contagiosum (MCI). OBJECTIVE: The purpose of this study was to evaluate the effect of DPCP immunotherapy on MC in children. METHODS: Twenty three patients with multiple lesion of MC were treated with DPCP immunotherapy. RESULTS: Twelve patients (52.2%) showed cure, and eleven patients (47.8%) showed treatment failure. No severe side effects were seen. CONCLUSION: DPCP immunotherapy may be an effective treatment in children with MC without serious side effects.

A Case of Molluscum Contagiosum Treated with Diphenylcyclopropenone Immunotherapy

We are reporting a case of molluscum contagiosum in a 3-year-old boy who showed a good response to diphenylcyclopropenone (DPCP) immunotherapy. The lesions were multiple, 2 to 7mm in size, centrally umbilicated, normal skin-colored papules of 7 months' duration which were distributed on the penoscrotal area, extremities and trunk. In spite of several treatments using extraction and curettage, new lesions developed continuously. The patient was sensitized with 0.1ml of 1% DPCP solution in acetone on his right shoulder and there-after challenged with solution of varying concentrations (0.05 to 0.1%) on his left shoulder once or twice a week to maintain a mild eczema. Clinical improvement was noted 1 week after sensitization and almost all of the lesions cleared after 8 week's treatment.