No abstract

Immunotherapy for resistant and/or severe alopecia areata in a university hospital setting in Northern MexicoAlopecia areata causes non-scarring alopecia usually involving the scalp; however, it can affect any part of the body. It can start at any age, with no gender predominance. [1][2][3] Its aetiology is autoimmune, mediated by TCD8+ lymphocytes. Severe forms are usually chronic and recurrent. [1][2][3][4] Multiple treatments have been described including topical and intralesional steroids, 3,5-7 topical immunotherapy 3,5,8 and inhibitors of the JAK pathway (tofacitinib), 6,7 all with variable results. 3,[5][6][7] For extensive or resistant cases, immunotherapy with squaric acid dibutylester (SADBE) and diphenylcyclopropenone (DPCP) remains a first-line alternative; however, reports on the use of this therapeutic option are scarce in Latin America. Its mechanism of action is unknown, although it is believed to induce antigenic competition by attracting cd4+T cells to the peribulbar region, changing the cd4+/cd8+T lymphocyte ratio. 5,7 Response rates to immunotherapy are varied within the literature, ranging from 4 to 87%. 5 A recent meta-analysis of 2227 patients reported a general growth of any amount of hair in 65.5% patients and complete regrowth in 32.3% with a relapse rate of 38.3% among patients with maintenance therapy and 49% in those without it. 8