[Dr.Anisimova]

Extensive alopecia areata: Not necessarily recalcitrant to therapy![Ссылки доступны только зарегистрированным пользователям ]
Conclusion: A combination therapy of oral steroid minipulse with topical anthralin and minoxidil acts synergistically, being effective as well as safe in treatment-resistant, extensive, long-standing alopecia areata.
Steroids have been useful in the treatment of alopecia areata. However, daily doses of steroids have significant treatment-related side effects. On the other hand, alternate day steroids or pulsed dosing may be inadequate. Therefore, the combination of topical minoxidil with anthralin along with oral mini-pulses of systemic steroid used in our study yields effective response, while being safe at the same time. Maintenance of cosmetic response can easily be achieved with only topical minoxidil and anthralin while gradually tapering and finally discontinuing oral steroids.
We propose that this combination therapy would provide a new approach in treatment-resistant, extensive, long-standing alopecia areata.
All patients were started on oral betamethasone mini-pulse (0.1 mg/kg/body weight on two consecutive days per week) along with 2-5% topical minoxidil and 1.15% anthralin cream. Oral minipulse was continued till the patient achieved a cosmetic response and then it was maintained for 6 to 9 months depending on the response attained. The oral minipulse was gradually tapered by 20% every three weekly after cosmetic response and then stopped. If response was not seen in six months then oral steroids were stopped. One milliliter of topical minoxidil was applied to the affected scalp and then was reapplied 12 h later. Anthralin cream was applied daily in the night 2 h after the last application of minoxidil for 10?min (contact time) initially, and thereafter the contact time was escalated every three weekly till mild erythema was seen. The contact time responsible for the mild erythema was maintained throughout the study period. Maximum contact time achieved was 1 h. The patients were instructed to clean the treatment area with mineral oil and water after the specified contact time. Topical minoxidil and anthralin was continued as maintenance therapy after stopping oral steroids. Maintenance therapy included tapering the number of applications of topical minoxidil to once a day, as well as anthralin to once or twice weekly.

Practicality in using diphenyl cyclo propenone for alopecia areata[Ссылки доступны только зарегистрированным пользователям ]
Diphenyl cyclo propenone (DPCP) is used as a topical immunomodulator in alopecia areata. DPCP was first used by Happle et al. for alopecia areata. [1] It is a potent contact allergen in humans and animals; 98-99% of the cases of alopecia areata can be sensitized on the scalp skin. [2] Although its use has been increasing of late, the process of procuring, dilution and storage at a particular concentration is cumbersome and limits its wide use. This short communication aims to make the DPCP preparation and application easy for the readers.
The common adverse effects after DPCP applications are local eczema with blistering, regional lymphadenopathy and contact urticaria. [3],[4] Rare adverse effects include an erythema multiforme-like reaction, hyperpigmentation, hypopigmentation and vitiligo.

Alteration in Hair Texture Following Regrowth in Alopecia Areata[Ссылки доступны только зарегистрированным пользователям ]
Conclusions The precipitating factor for a change in hair texture in alopecia areata may be a result of treatment, pathophysiologic changes, or a combination of both. Whether the change is triggered at the level of stem cell differentiation, by cytokine or hormonal influences, gene expression during hair follicle development, a combination of all of these, or an unknown cause is a question that remains to be answered.