Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter To Editor
2008:74:4;401-402
doi: 10.4103/0378-6323.42924
PMID: 18797078

Topical dinitrochlorobenzene (DNCB) for alopecia areata: Revisited

KH Mohan, C Balachandran, SD Shenoi, Raghavendra Rao, H Sripathi, Smitha Prabhu
 Department of Dermatology, Kasturba Medical College, Manipal, Karnataka, India

Correspondence Address:
K H Mohan
Department of Dermatology, KMC, Manipal - 576 104, Udupi, Karnataka
India
How to cite this article:
Mohan K H, Balachandran C, Shenoi S D, Rao R, Sripathi H, Prabhu S. Topical dinitrochlorobenzene (DNCB) for alopecia areata: Revisited. Indian J Dermatol Venereol Leprol 2008;74:401-402
Copyright: (C)2008 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Treatment of alopecia areata with topical immunotherapy by contact sensitizers is an effective and accepted therapeutic modality in the treatment of chronic severe alopecia areata . [1],[2] The contact sensitizers used in alopecia areata are dinitrochlorobenzene (DNCB), diphenyl-cyclo-propenone (DPCP) [3] and squaric acid dibutyl ester (SADBE). We used DNCB in the treatment of chronic resistant alopecia areata. [4]

DNCB powder was dissolved in acetone and diluted in appropriate concentrations of 0.001%, 0.01%, 0.05%, 0.1%, 0.5%, 1%, 1.5% and 2% solutions. Solution was stored in dark bottles until use in room temperature. DNCB was applied using cotton buds. Sensitization was done by applying 2% DNCB over 4 x 4 cm area on back during the first visit. After 1 week, weekly applications of DNCB were done starting with lowest concentration (0.001%) to the affected area of hair loss. Patients were advised to avoid washing the area and protect it from sunlight for 48 hours. Applications of DNCB were repeated weekly with increasing concentrations. Aim was to produce moderate eczema. Mild to moderate eczema was maintained by titrating the DNCB concentrations. The patients were advised to inform about any side effects during the treatment period. If there was no sensitivity after 12 weeks, it was considered as treatment failure and the patient was withdrawn from the study.

A total of 22 patients were included in the study. The total duration of the study was 6 months. All the patients completed the study period. Out of 22 patients, 2 patients had only beard involvement, 8 had only scalp, 3 had ophiasis pattern, 5 had alopecia totalis and 4 had alopecia universalis. Complete hair growth with terminal hairs was seen in 8 (36.36%) patients and 4 patients did not respond at all. Remaining 10 patients had variable response. Side effects observed during the study period were hyperpigmentation, irritation, fever and lymphadenopathy. Six months of follow-up was done in 20 patients, 2 patients were lost to follow-up. Two patients with complete hair growth developed patchy hair loss after 3 months during the follow-up period.

The only disadvantage of DNCB is its mutagenicity by Ames test. However, drugs like norfloxacin, isoniazid and psoralen with ultraviolet A (PUVA) treatment, textile dyes and fumes of oils have also been found mutagenic by Ames test. [5],[6],[7] The most potent mutagenic agent in early trials of Ames test is parsnip juice. DNCB was found non-carcinogenic when fed in large doses in rats, mice, guinea pigs and man. Happle and Edternacht et al , [5] had a good response with DNCB. The effect was seen in all 7 patients with moderate hair loss, in 12 out of 13 patients with extensive hair loss and in 14 out of 23 patients with alopecia areata totalis. Treatment was successful in 26 out of 31 patients with a history of duration of disease 5 years or less and 7 out of 12 patients with history of more than 5 years. There is renewed interest in the immunomodulatory effects of topical DNCB in patients with human immunodeficiency virus (HIV) infection and systemic lupus erythematosus. [7] During almost 10 years of topical DNCB therapy in HIV patients world wide, the only reported side effect has been localized dermatitis at the application site. [8] We believe that in view of the reports of efficacy of DNCB therapy, [9],[10] DNCB requires a relook as an option in alopecia areata rather than other contact sensitizers that are available only with difficulty and are expensive. [11]

References
1.
Breuillard F, Szapiro I. Dinitrochlorobenzene in alopecia areata. Lancet 1978;2:1304.
[Google Scholar]
2.
Cotteril JA, Psychiatry and skin diseases. In: Rook AJ, Maibach HI,editors. Recentadvances in dermatology No.6. Edinburgh: Churchill Livingstone; 1983. p. 189-212.
[Google Scholar]
3.
van der Steen PH, van Baar HM, Happle R, Boezeman JB, Perret CM. Prognostic factors in the treatment of alopecia areata with diphenylcyclopropenone. J Am Acad Dermatol 1991;24:227-30.
[Google Scholar]
4.
Warin AP. Dinitrochlorobenzene in alopecia areata. Lancet 1979;3:927.
[Google Scholar]
5.
Happle R, Echternacht K. Induction of hair growth in alopecia areata with DNCB. lancet 1977;2:1002-3.
[Google Scholar]
6.
Rokhsar CK, Shupack JL, Vafai JJ, Washenik K. Efficacy of topical sensitizers in the treatment of alopecia areata. J Am Acad Dermatol 1998;39:751-61.
[Google Scholar]
7.
Stricker RB, Elswood BF. Dendritic cells and dinitrochlorobenzene (DNCB): A new treatment approach to AIDS. Immunol Lett 1991:29:191-6.
[Google Scholar]
8.
Stricker RB, Elswood BF. Topical dinitrochlorobenzene in HIV disease. J Am Acad Dermatol 1993;28:796-7.
[Google Scholar]
9.
Singla A, Mittal RR, Walia RL, Bansal IJ. Comparative efficacy of topical DNCB and PUVASOL therapy in alopecia areata. Indian J Dermatol Venereol Leprol 1991;57:284-6.
[Google Scholar]
10.
Khopkar U, Nigale V, Trasi SS, Wadhwa SL. Topical dinitrochlorobenzene (DNCB) in alopecia areata. Indian J Dermatol 1990;35:103-6.
[Google Scholar]
11.
Singh G, Okade R, Naik C, Dayanand CD. Diphenylcyclopropenone immunotherapy in ophiasis. Indian J Dermatol Venereol Leprol 2007;73:432-3.
[Google Scholar]

Fulltext Views
483

PDF downloads
78
Show Sections