Squaric Acid Dibutylester (SADBE) Treatment for Alopecia Areata
Alopecia areata is an inflammatory condition that results in hair loss and can occur in people of all ages and both sexes. The hair loss can occur on the scalp, the eyebrows, the eyelashes and, rarely, the entire body. One treatment option available to combat alopecia areata is through squaric acid dibutylester or SADBE for short. Squaric acid dibutylester is one of three major treatments using contact sensitizers, topical sensitizers being applied to the affected scalp area to try to encourage hair growth
Effect of SADBE
How these contact sensitizers, such as squaric acid dibutylester, work is not really known. It is thought that it could be antigen competition, that they divert the attention of the inflammatory cells to them, thus moving them away from the hair follicles and allowing the affected area to re-grow.
Application of treatment
Typically with contact sensitizer’s treatment begins with the application of a measured amount of the medication being applied to the scalp to determine any allergic reaction such as itching and inflammation which eventually leads to hair growth. Such a response may be over a period of 3 to 12 months so treatment is never a “quick fix”. A diluted concentration of 0.0001 to 0.001 of SADBE is applied to the affected area and adjusted on a weekly basis to judge the most effective amount that can be applied without discomfort to the patient. It usually takes 8 to 10 weeks for hair growth after the commencement of treatment. The frequency of the treatment can then be reduced until the growth is complete after which treatment can then be stopped. If there is a relapse the whole procedure has to be repeated.
Result of treatment
Initially the topical sensitizers are applied to one half of the affected area the other half being left untreated which allows the untreated half to be used as a guide to judging the effects. Once there is growth on the one half then the whole area can be treated until there is hair growth in the whole area. No matter how successful the treatment may appear to be there is always a relapse that may occur which can place patients in a psychologically stressed state wondering if the treatment is successful or not. The success rate of SADBE compares well with other forms of treatment with a median response rate of 43% but in the use of contact sensitizers there are three factors which would give a negative prognosis, being the area of scalp affected, the length of time that the condition was present before treatment commenced and nail abnormalities.
Side effects
Remarkably there are few side effects reported with alopecia areata certainly in the long term, and this is after 20 + years of such treatment. There are short term effects which consist of severe contact dermatitis which is hardly surprising considering the application of solutions to the skin. Pruritis or severe itching is also a side effect as is erythema which is simply reddening of the skin. The more serious side effects are abnormal enlargement of the lymph nodes. Another short term effect is vitiligo which is another autoimmune condition.
Conclusion
Like most things connected to the condition, the treatments and the effects are hit or miss. Although contact sensitizers have never been thoroughly tested they do seem to have a positive effect in some patients though it could well be argued that if it had been left alone there may have been improvements that compared favorably with this form of treatment.