11/18/2023 0 Comments Metaz ointment topical corticosteroid![]() 39 Also, in another uncontrolled open-label study, complete hair regrowth was reported in 27.3% of subjects. A moderate response was seen in 30.7% of patients. In an uncontrolled prospective trial of sulfasalazine in 39 patients with persistent alopecia areata, hair regrowth of more than 60% was achieved in 25.6% of patients. Several case reports and case series showed good hair regrowth with sulfasalazine in the treatment of alopecia areata. ![]() 38 Sulfasalazine has been used safely as a long-term treatment of various inflammatory and autoimmune diseases, including inflammatory bowel disease and rheumatoid arthritis. Sulfasalazine has both immunomodulatory and immunosuppressive actions that include suppression of T cell proliferation and reducing the synthesis of cytokines, including interleukin (IL) 6, 1, and 12, tumor necrosis factor alpha, and antibody production. Sulfasalazine is a combination of sulfapyridine and 5-aminosalicylic acid linked by a diazo bond. The mechanism of action of topical sensitizers could be due to perifollicular lymphocyte apoptosis, 24 changes in the peribulbar CD4/CD8 lymphocyte ratio, 25, 26 and antigenic competition. 20 In a retrospective study of 121 patients with extensive alopecia areata, fexofenadine hydrochloride has been shown to enhance the efficacy of topical immunotherapy. 20 – 22 Recurrence of alopecia areata after achieving significant hair regrowth developed in 62.6% of patients. 20 Several negative prognostic factors in the treatment of alopecia areata with diphenylcyclopropenone have been suggested, including long duration of disease, alopecia totalis/alopecia universalis, nail changes, atopy, and family history of alopecia areata. The response rate of alopecia totalis/alopecia universalis patients to diphenylcyclopropenone was 17.4% in the largest reported diphenylcyclopropenone study, whereas the cumulative patient response was 77%. 16, 17 The adverse effects to topical sensitizers include cervical lymphadenopathy, a severe eczematous reaction, urticaria, and postinflammatory pigment changes. SADBE may be tried in poor responders to diphenylcyclopropenone or in those who do not develop a sensitization to 2% diphenylcyclopropenone. If there is no response after 6 months of treatment, diphenylcyclopropenone can be discontinued. Diphenylcyclopropenone is applied on a weekly basis by a trained nurse. Both sides of the scalp can be treated from the start also. ![]() Once hair regrowth is obtained on the treated half of the scalp, both sides are treated. The scalp should be protected from the sun during this time. 15 The solution should be on the scalp for 48 hours. The diphenylcyclopropenone concentration is increased gradually every week until mild dermatitis is observed. After two weeks, 0.001% diphenylcyclopropenone solution is applied to the same half of the scalp. Initially the patient is sensitized using a 2% solution of diphenylcyclopropenone applied to a 4 × 4 cm area of the scalp. 13 Diphenylcyclopropenone is lightsensitive and should be protected from light. SADBE is expensive and not stable in acetone. 12 Diphenylcyclopropenone is the topical sensitizer of choice. Dinitrochlorobenzene is no longer used because it was shown to be mutagenic in the Ames test. Topical sensitizers that have been used in the treatment of alopecia areata include diphenylcyclopropenone, squaric acid dibutylester (SADBE), and dinitrochlorobenzene. Although the effect of a single intralesional corticosteroid injection has been observed to persist for up to 9 months, 3 reported relapse rates were 29% in limited alopecia areata and 72% in alopecia totalis during a 3-month follow-up period. To alleviate injection pain, topical anesthetic may be applied 30–60 minutes before the treatment. 2 Side effects include skin atrophy and telangiectasia which can be minimized by the use of smaller volumes and avoiding superficial injections. The use of mesotherapy multi-injectors with 5–7 needles is an alternative approach to decrease injection pain and to make the procedure more homogenous. The injections can be repeated at 4–6 weekly intervals. Corticosteroid is injected into the deep dermis level or just beneath the dermis in the upper subcutis. A maximum volume of 3 mL on the scalp in one visit is recommended. ![]() Different concentrations of triamcinolone acetonide are used, in the range of 2.5–10 mg/mL, but 5 mg/mL is the preferred concentration for the scalp and face. The most widely used agent is triamcinolone acetonide. 1 For limited scalp alopecia areata, intralesional corticosteroid therapy is considered as the drug of choice by many experts. Abell and Munro reported hair regrowth in 71% of patients with subtotal alopecia areata treated by triamcinolone acetonide injections and in 7% of a placebo group. Several studies have shown the efficacy of intralesional corticosteroid injections. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |