Efficacy and Safety of the Topical Sensitizer Squaric Acid Dibutyl Ester in Alopecia Areata and Factors Influencing the Outcome

Background: Immunotherapy with sqauric acid dibutyl ester (SADBE) is a well-accepted therapy for alopecia areata.

Objective: To study efficacy, safety, and factors influencing the outcome in the treatment of alopecia areata.

Method: During a 4-year period, 70 patients of alopecia areata, unresponsive to conventional therapies, were treated with SADBE for a period of 4 months and thereafter depending on the response with initial therapy. The percent scalp hair loss was calculated using “Severity of Alopecia Tool” (SALT) score before and after the therapy.

Results: Out of 70 patients, 6 were lost to follow-up and 4 could not develop sensitization; therefore, data of 60 patients was available for analysis. The overall success rate was 43%. In patients with <50% scalp involvement; the success rate was better (68%) than in those with >50% involvement (29%). The response was better in patients with late onset and shorter duration of disease. Family history of alopecia areata or other autoimmune diseases, personal or family history of atopy, presence of auto antibodies in serum, and presence of nail changes were associated with poorer prognosis. Out of 26 patients who responded, relapse occurred in 21 (81%) patients.

Conclusion: In conclusion, SADBE is an effective and well-tolerated mode of therapy in Indian patients of AA, although the long-term results of SADBE were not encouraging.