SUMMARY OF PROPOSED RESEARCH

Alopecia areata (AA) is an autoimmune disease that presents as patches of non-scarring alopecia, most commonly over the scalp but can be severe enough to involve all body hair. It is a common disease encountered by dermatologists, with a frequency ranging from 0.7% to 3.8% of patients attending dermatology clinic¹ and 60% of cases occuring below 20years.¹ The most accepted hypothesis in the pathogenesis of AA is an autoimmune etiology. Management of AA depends on the severity of the disease and age of the patient. The various therapeutic modalities employed include topical corticosteroids, intralesional corticosteroids, systemic corticosteroids, systemic immunomodulators like methotrexate and azathioprine, contact immunotherapy with squaric acid dibutyl ester and diphenyl cyclopropene, topical anthralin and psoralen plus ultraviolet A (PUVA) therapy.² A recent Cochrane review has shown that few therapies for alopecia areata (AA) have been comprehensively evaluated in randomized controlled trials.³ AA presenting as unifocal or multifocal patches can be treated with topical/intralesional steroids. For more extensive disease systemic corticosteroids or immunotherapy may be required. Few studies have looked at therapies for this disorder in children, so much of the data are derived from adult literature and describe off-label use of medication. Topical corticosteroids are the preferred first-line therapy for pediatric alopecia areata.

Several forms of systemic corticosteroids have been described in the literature with variable success rates (30-60%).^4,5Various ways of administering systemic corticosteroids that have been tried in AA include alternating daily doses of oral prednisone, high dose of once monthly prednisolone, intravenous methyl- prednisolone and dexamethasone oral mini pulse (OMP) 2.5-5 mg twice weekly for a minimum period of 12 weeks.^6,7,8 Drawbacks to systemic corticosteroids include their adverse effect profile and the high relapse rate after reduction of the dose necessitating a maintenance regimen to maintain the achieved hair regrowth. Corticosteroid pulse therapy seems to have less of a side effect profile than daily or alternate day oral regimens. Contact immunotherapy has also shown a promising therapy fpr extensive AA with good response rates. Benefit of using DPCP lies in the fact that the drug has very limited cutaneous side effects like irritant reaction , eczema, urticaria, with no systemic side effects. There is paucity of data in literature comparing the efficacy of oral mini pulse corticosteroids with DPCP contact sensitization.