What Is It?

You are trying a novel therapy for alopecia called squaric acid, or squaric acid dibutyl ester. This is a very dilute solution that causes an allergic reaction in the skin, and which has been shown to help alopecia resolve.

The therapy will begin with an application of the solution to the forearm. This usually causes no reaction, although the occasional patient will get some mild redness. Even though you see no reaction at the site where the solution was applied, this does not mean it is not working correctly.

You will be instructed on the application of the solution to the areas of alopecia, which you will start 1-2 weeks after the application in the office. Using the Q-tip, put enough of the medicine on the area to treat the area without run-off. It will evaporate quickly, and leave no residue. Do not reapply, even if you feel too little was applied. You should wear gloves when applying the medicine, and apply it with Q-tips, only to the affected areas (the actual alopecia). Be sure to keep the medicine out of reach of children.

The medicine should initially be applied 3 times per week, preferably at night. The goal of treatment is to have some mild redness of the alopecia, without causing a reaction that will cause your child to be uncomfortable (ie pain or marked itching). Gradually increase the frequency of applying the medication, on a weekly basis (ie 4 nights per week, then 5 nights per week, etc). If you experience severe itching or discomfort, do not increase the frequency of application.

Side-effects can include redness, tiny blisters, pustules and broken skin at the site of application. If this occurs, stop the therapy immediately and call us. You will be prescribed a strong cortisone cream to stop the irritation. Use it twice a day until the irritation disappears, then restart the therapy at the previous interval. Irritation or dermatitis may occur at the site of sensitization on the forearm as long as a month after the start of therapy. Do not be concerned, but do stop the medicine and call us immediately.

Remember that some redness is necessary in order for the medication to help. We do not want broken skin or infection. Also keep in mind that this treatment takes time, sometimes as long as several months, before you begin to see results. As with all treatments for alopecia, squaric acid does not work in all patients. If it seems to be ineffective, your doctor will discuss other alternatives. Recurrence, or rate of return, varies with the patient. Please have reasonable expectations.

Medicine:

Sensitization (done in office)	2% Squaric Acid Dibutyl Ester
Treatment	0.2% Squaric Acid Dibutyl Ester

Top Of Page