Squaric acid dibutylester topical immunotherapy works against alopecia areata

Topical immunotherapy with squaric acid dibutylester (SADBE) appears to be effective in the treatment of alopecia areata (AA), according to a study, lending support to current treatment guidelines recommending the use of topical immunotherapies.

The retrospective study involved 49 alopecia patients who had received topical immunotherapy with SADBE. Efficacy was assessed by measuring the change in alopecia severity at 6 and 12 months after treatment initiation. Complete and partial responses were quantified to calculate the improvement rate.

Hair loss was classified as follows: S0 or no loss; S1 or <25 percent loss; S2 or 25–49 percent loss; S3 or 50–74 percent loss; S4 or 75–99 percent loss; S5 or total scalp hair loss (alopecia totalis [AT]); and S5B2 or total scalp and body hair loss (alopecia universalis [AU]). Severe AA was defined as S3, S4, S5 or S5B2. Of the patients, five had S1, eight had S2, 13 had S3, seven had S4, two had S5 and 14 had S5B2 disease. 

Six months following the first application of SADBE, remission occurred in two patients in the S1 group and one in the S2 group. Disease severity decreased from S3 to S1 in seven patients and from S4 to S2 in two patients. One of two AT patients and 10 out of 14 AU patients exhibited notable hair regrowth.

Overall, complete and partial response rates were 11.1 percent and 46.7 percent, respectively, yielding an improvement rate in all alopecia patients treated with SADBE topical immunotherapy of 57.8 percent.

Area of hair loss was maintained or further improved at the 12-month follow-up in all patients who showed symptom improvement at month 6.

Researchers pointed out that while topical immunotherapy is effective, treatment does not always induce remission and some patients can experience a recurrence of AA after treatment discontinuation. This underscores a need to evaluate therapies other than topical immunotherapy for the treatment of AA.