Phototherapy as a useful therapeutic option in the treatment of diphenylcyclopropenone-induced vitiligo.

Alopecia areata (AA) is an inflammatory non-scarring hair loss that affects the anagen-stage hair follicles. It is determined by an autoimmune process and characterized histologically by peri-and intra-follicular infiltration of CD4+ and CD8+ T cells (1). At present the most effective therapy for AA is di phenylcyclopropenone (DPCP), a contact sensitizer that has been used in the treatment of extensive AA since 1983. The immunological mechanism of action of DPCP is unknown (2). Vitiligo is one of a number of adverse events result ing from the application of DPCP and, like Vulgaris-type vitiligo, it represents a great challenge for dermatologists , due to its significant resistance and recalcitrance to many conventional therapies. We report here a case of DPCP-induced vitiligo in a patient with AA, which was treated successfully with phototherapy. CAse rePort A 34-year-old man, who had developed AA 6 months previously, was referred to our clinic. the disease involved part of the right parietal area, one patch on the edge of the scalp and the occipital area. Anamnesis was negative for remarkable disease, thyroid disease, autoimmune dis orders and atopic dermatitis; no familiar or personal history of vitiligo was identified. the AA was resistant to topical and systemic corticosteroid therapy, thus DPCP therapy was commenced. After 2 weeks of sensitization with DPCP 2% in ace-tone on a 2 × 2 cm area of the affected occipital patch, increasing concentrations of DPCP (from 0.0001% to 0.5%) were applied progressively in all alopecic areas. DPCP 0.5% was determined as the therapeutic dosage to obtain pruritus and local erythema. Initial hair regrowth commenced after approximately 10 weeks of topical treatment. After 24 weeks the patch on the vertex was completely covered by terminal hair, and there was an 85% regrowth on the occipital and parietal areas, and a significant improvement in the patient's psychological profile. After 9 months of treatment, the patient developed significant acute contact eczema with blistering on the occipital area after the usual application of DPCP 0.5%, and thus application was discontinued and the dermatitis treated with oral steroids and antihistamines. Vitiligo appeared after resolution of the contact dermatitis in all areas treated with DPCP, not only the occipital ones. Distant sites were not involved. At the same time the AA returned and increased progressively in the same areas (Fig. 1A). DPCP was stopped, and after a failed attempt with topical and oral steroids to treat the rapid …