Contact allergy as a therapeutic tool for alopecia areata: application of squaric acid dibutylester.

Squaric acid dibutylester (SADBE), a potent contact allergen, was tested for mutagenicity in the bacterial plate incorporation assay (Ames test), in the presence and absence of mammalian microsomes. In contrast to dinitrochlorobenzene which is mutagenic in this test, SADBE was found not to be mutagenic. In 53 patients with extensive or total alopecia areata, SADBE dissolved in acetone was applied weekly to one side of the head, the other side serving as control. In 46 patients (87%), hair regrew either exclusively on the treated side, or considerably faster and denser on this side. In some patients, continuous treatment failed to maintain the response. Persistent response was observed in 37 patients (70%). These results are essentially the same as those obtained with DNCB. Therefore, contact allergy is proposed as a therapeutic concept for alopecia areata.