Immunotherapy

A Specialist Treatment for Alopecia Areata

Contact immunotherapy is a specialist treatment used in the management of alopecia areata, particularly where hair loss is more extensive.

Alopecia areata is an autoimmune condition in which the immune system targets the hair follicle. Contact immunotherapy works differently from regenerative hair treatments: rather than attempting to stimulate a normal follicle directly, it deliberately creates a controlled immune reaction in the skin.

It is therefore relevant to a specific diagnosis and is not a general treatment for thinning hair.

How Does Contact Immunotherapy Work?

Treatment involves applying a sensitising substance to the affected skin.

The aim is to create a controlled allergic contact dermatitis — an immune response that may alter the inflammatory activity associated with alopecia areata and allow hair growth to resume in some patients.

One of the agents most commonly associated with this approach is diphenylcyclopropenone (DPCP).

Current British Association of Dermatologists guidance recommends DPCP, where available, as an option for people with moderate-to-severe alopecia areata.

Who May Be Suitable?

Contact immunotherapy is generally considered for selected patients with a confirmed diagnosis of alopecia areata.

Suitability depends on factors such as:

• Extent of hair loss
• Duration of the condition
• Rate of progression
• Previous treatment
• Age
• Medical history
• Scalp condition
• Individual treatment preferences

Alopecia areata can behave unpredictably, and no treatment can guarantee permanent regrowth.

What Does Treatment Involve?

Contact immunotherapy requires an initial sensitisation process followed by repeated carefully controlled applications.

Treatment strength is adjusted according to the skin response.

Because the intention is to produce a mild controlled dermatitis, patients may experience:

• Redness
• Itching
• Scaling
• Irritation
• Local discomfort

More significant reactions can occasionally occur, which is why treatment requires appropriate clinical supervision.

Why Diagnosis Matters

Contact immunotherapy is not appropriate for male or female pattern hair loss, telogen effluvium or established scarring alopecia.

Patchy hair loss should therefore be assessed before treatment is considered.

Where there is uncertainty about diagnosis or the condition requires specialist dermatological management, onward referral may be appropriate.

Supporting Patients With Alopecia Areata

Treatment is only one aspect of managing alopecia areata.

Depending on the extent and impact of hair loss, patients may also wish to consider medical wigs, toppers or other hair-replacement options.

BAD guidance recognises hair replacement as an important part of improving quality of life for some people living with alopecia areata.