Alopecia Patients Turning to Compounding R.Ph.S for Help

By Gebhart, Fred | Drug Topics, February 5, 2001 | Go to article overview

Alopecia Patients Turning to Compounding R.Ph.S for Help


Gebhart, Fred, Drug Topics


What do Princess Caroline of Monaco and Al Pacino have in common? They are two celebrities who reportedly have suffered from alopecia areata (AA), which causes hair loss.

Two topical immunotherapeutics compounded by pharmacists to treat hair loss are slated for clinical trials early this year. Eleven dermatology centers in the United States and Canada have joined the first-ever safety and efficacy trials for diphenylcyclopropenone (DPCP) and squaric acid dibutyl ester (SADBE) in treating AA. A third compounded product, dinitrochlorobenzene (DNCB), is not included in the trial.

Dermatologists in the United States, Canada, and Europe have been using the three compounds for decades, said Richard Strick, M.D., clinical professor of dermatology at the University of Callfornia Los Angeles Medical Center. All are potent contact allergens, and none has been approved for use in humans by the Food & Drug Administration.

Pharmaceutical manufacturers aren't interested in FDA approvals, Strick said. The potential market is relatively small, and all three compounds are in the public domain and cannot be patented. With no medical supplier, clinicians have turned to compounding pharmacists. "The recipes are simple enough," said David Sparks, president and CEO of Professional Compounding Centers of America. "But you need extreme safety precautions to avoid skin contamination."

How extreme? Pharmacists at UCLA who compound DNCB for Strick and other physicians use negative pressure hoods; neoprene gowns; and gloves, masks, and face shields. "Most pharmacists wouldn't want to prepare it just because of what it is," cautioned UCLA drug information specialist Ed Arriola. "It's a potent sensitizing agent." So potent that Strick has seen positive results with concentrations as low as 10-6% (.00001%). Most patients use a .1% or .01% product.

"These contact allergens are by far the most effective and safest treatments out there for severe alopecia areata," Strick explained. "When you treat a 17-year-old girl and see her hair grow back, you know there's something there."

Strick has been using DNCB since the 1970s, first to treat skin cancer and later to regrow hair on balding AA patients. AA is an autoimmune disease in which T lymphocytes attack the lower portion of hair follicles and suppress hair growth. The patient's hair falls out in patches and often fails to regrow.

About 2% of the population is affected by AA, according to population studies from the mid-1990s. …

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