WCD: Topical squaric acid may help alopecia areata in kids

VANCOUVER, B.C. – If you haven’t tried topical 5% squaric acid dibutylester for alopecia areata in children, you probably should, according to investigators at the University of Texas in Houston.

“We have treated over 500 patients” with decent results. “A lot of children referred to us had failed topical steroids or kenalog injections. If you don’t have this in your practice and you are treating this population, this is something you really have to look into,” said investigator Dr. Marjon Vatanchi, a dermatology research fellow at the university.

She shared outcomes for 10 children, a mix of boys and girls aged 3-12 years, at the World Congress of Dermatology.

Overall, five had a good response to squaric acid, meaning regrowth of 75% or more of their hair, and three had a fair outcome, meaning regrowth of 25%-74%.

Seven had failed previous treatment with kenalog, topical steroids, minoxidil, and tacrolimus ointment. Hair regrowth was good in three and fair in two. The two poor responders – 4- and 10-year-old girls – both had areata universalis, which seems to be less responsive to treatment then areata totalis.

Two of the three children who hadn’t been treated before – a 3-year-old boy and 4-year-old girl, both with areata totalis – had a good response. The third, a 12-year-old girl with areata universalis, had a fair response.

In all, 50% of the children had a good outcome, and 71% who had failed previous treatments had a favorable outcome. It usually took 2-4 monthly treatments to see a response, but some patients needed up to 17 treatments.

The results from the University of Texas are on the high end of what’s been reported before, and that might have something to do with how squaric acid is used there.

After ruling out hormonal and other causes of hair loss and explaining the possible side effects, “the first thing we do is a patch test,” applying the solution to a small affected area to see how children respond, Dr. Vatanchi said.

Patients are then sent home with instructions to wash the area and apply a topical steroid if the irritation becomes too much. Itching, redness, and blistering can occur, but “most people don’t have a terrible reaction,” she said.

Patients come back in a month, and if there were no problems, then the whole head is treated. The solution is applied with cotton swabs to moisten the affected areas. It usually takes one to six swabs. “You don’t have to do every single centimeter, because what you are trying to do is stimulate the scalp,” she said.

Children keep the solution on overnight, and wash it off in the morning.

They return to the office the following month. “At that point, I am looking for any new hairs. If they have good regrowth, we continue with the 5% solution, one treatment once a month. If I don’t see any hair regrowth, then we go up to 10%. If they come back and say they had burning or blistering, we go down to 2.5%,” Dr. Vatanchi said. Treatment continues until it’s no longer needed.

“Many children will outgrow alopecia areata, but like [with] eczema, we tell parents we don’t know what the future holds. We treat what we can and hope children grow out of it,” she said.

Although there are several theories, it’s unknown why squaric acid, which is generally available from compounding pharmacies, helps with alopecia.

There was no funding for the project, and Dr. Vatanchi reported having no relevant financial disclosures.

[email protected]

VANCOUVER, B.C. – If you haven’t tried topical 5% squaric acid dibutylester for alopecia areata in children, you probably should, according to investigators at the University of Texas in Houston.

“We have treated over 500 patients” with decent results. “A lot of children referred to us had failed topical steroids or kenalog injections. If you don’t have this in your practice and you are treating this population, this is something you really have to look into,” said investigator Dr. Marjon Vatanchi, a dermatology research fellow at the university.

She shared outcomes for 10 children, a mix of boys and girls aged 3-12 years, at the World Congress of Dermatology.

Overall, five had a good response to squaric acid, meaning regrowth of 75% or more of their hair, and three had a fair outcome, meaning regrowth of 25%-74%.

Seven had failed previous treatment with kenalog, topical steroids, minoxidil, and tacrolimus ointment. Hair regrowth was good in three and fair in two. The two poor responders – 4- and 10-year-old girls – both had areata universalis, which seems to be less responsive to treatment then areata totalis.

Two of the three children who hadn’t been treated before – a 3-year-old boy and 4-year-old girl, both with areata totalis – had a good response. The third, a 12-year-old girl with areata universalis, had a fair response.

In all, 50% of the children had a good outcome, and 71% who had failed previous treatments had a favorable outcome. It usually took 2-4 monthly treatments to see a response, but some patients needed up to 17 treatments.

The results from the University of Texas are on the high end of what’s been reported before, and that might have something to do with how squaric acid is used there.

After ruling out hormonal and other causes of hair loss and explaining the possible side effects, “the first thing we do is a patch test,” applying the solution to a small affected area to see how children respond, Dr. Vatanchi said.

Patients are then sent home with instructions to wash the area and apply a topical steroid if the irritation becomes too much. Itching, redness, and blistering can occur, but “most people don’t have a terrible reaction,” she said.

Patients come back in a month, and if there were no problems, then the whole head is treated. The solution is applied with cotton swabs to moisten the affected areas. It usually takes one to six swabs. “You don’t have to do every single centimeter, because what you are trying to do is stimulate the scalp,” she said.

Children keep the solution on overnight, and wash it off in the morning.

They return to the office the following month. “At that point, I am looking for any new hairs. If they have good regrowth, we continue with the 5% solution, one treatment once a month. If I don’t see any hair regrowth, then we go up to 10%. If they come back and say they had burning or blistering, we go down to 2.5%,” Dr. Vatanchi said. Treatment continues until it’s no longer needed.

“Many children will outgrow alopecia areata, but like [with] eczema, we tell parents we don’t know what the future holds. We treat what we can and hope children grow out of it,” she said.

Although there are several theories, it’s unknown why squaric acid, which is generally available from compounding pharmacies, helps with alopecia.

There was no funding for the project, and Dr. Vatanchi reported having no relevant financial disclosures.

[email protected]

VANCOUVER, B.C. – If you haven’t tried topical 5% squaric acid dibutylester for alopecia areata in children, you probably should, according to investigators at the University of Texas in Houston.

“We have treated over 500 patients” with decent results. “A lot of children referred to us had failed topical steroids or kenalog injections. If you don’t have this in your practice and you are treating this population, this is something you really have to look into,” said investigator Dr. Marjon Vatanchi, a dermatology research fellow at the university.

She shared outcomes for 10 children, a mix of boys and girls aged 3-12 years, at the World Congress of Dermatology.

Overall, five had a good response to squaric acid, meaning regrowth of 75% or more of their hair, and three had a fair outcome, meaning regrowth of 25%-74%.

Seven had failed previous treatment with kenalog, topical steroids, minoxidil, and tacrolimus ointment. Hair regrowth was good in three and fair in two. The two poor responders – 4- and 10-year-old girls – both had areata universalis, which seems to be less responsive to treatment then areata totalis.

Two of the three children who hadn’t been treated before – a 3-year-old boy and 4-year-old girl, both with areata totalis – had a good response. The third, a 12-year-old girl with areata universalis, had a fair response.

In all, 50% of the children had a good outcome, and 71% who had failed previous treatments had a favorable outcome. It usually took 2-4 monthly treatments to see a response, but some patients needed up to 17 treatments.

The results from the University of Texas are on the high end of what’s been reported before, and that might have something to do with how squaric acid is used there.

After ruling out hormonal and other causes of hair loss and explaining the possible side effects, “the first thing we do is a patch test,” applying the solution to a small affected area to see how children respond, Dr. Vatanchi said.

Patients are then sent home with instructions to wash the area and apply a topical steroid if the irritation becomes too much. Itching, redness, and blistering can occur, but “most people don’t have a terrible reaction,” she said.

Patients come back in a month, and if there were no problems, then the whole head is treated. The solution is applied with cotton swabs to moisten the affected areas. It usually takes one to six swabs. “You don’t have to do every single centimeter, because what you are trying to do is stimulate the scalp,” she said.

Children keep the solution on overnight, and wash it off in the morning.

They return to the office the following month. “At that point, I am looking for any new hairs. If they have good regrowth, we continue with the 5% solution, one treatment once a month. If I don’t see any hair regrowth, then we go up to 10%. If they come back and say they had burning or blistering, we go down to 2.5%,” Dr. Vatanchi said. Treatment continues until it’s no longer needed.

“Many children will outgrow alopecia areata, but like [with] eczema, we tell parents we don’t know what the future holds. We treat what we can and hope children grow out of it,” she said.

Although there are several theories, it’s unknown why squaric acid, which is generally available from compounding pharmacies, helps with alopecia.

There was no funding for the project, and Dr. Vatanchi reported having no relevant financial disclosures.

[email protected]