Alopecia areata may be helped with squaric acid dibutylester treatment

J Dermatolog Treat. 2005 Feb;16(1):10-4.

Topical immunomodulator therapy with squaric acid dibutylester (SADBE) is effective treatment for severe alopecia areata (AA): results of an open-label, paired-comparison, clinical trial.

Dall'oglio F, Nasca MR, Musumeci ML, La Torre G, Ricciardi G, Potenza C, Micali G.

Dermatology Clinic, University of Catania, Catania, Italy.

Severe alopecia areata (AA) may have a chronic relapsing course and is often resistant to current treatments. OBJECTIVES: The aim of our study was to evaluate whether topical immunotherapy with squaric acid dibutylester (SADBE) is able to improve the course of severe AA and to reduce the severity of relapses.

METHODS: Fifty-four patients affected by severe AA treated with SADBE who were followed for a period of at least 2 years were selected as the study group. Data collected were compared with those of a matched control group of 54 patients who did not receive any treatment. Student's t-test, analysis of variance (ANOVA) and Pearson's chi-squared test were utilized for data analysis.

RESULTS: At the end of therapy, in comparison with the control group, the treatment group showed a statistically significant (p < 0.001) improvement. At follow-up, there was no significant change in relapse rate (treated 44% vs control 52%). However, relapses in the treated group were significantly less severe compared with the control group (p < 0.001).

CONCLUSIONS: Our data suggest that topical SADBE represents a valid therapeutic option in severe AA, and may prove to be disease modifying.


Alopecia areata means hairloss in patches and is considered to be an autoimmune condition, meaning that the bodyís immune system is targeting its own tissue, in this case hair follicles. The pattern of loss, as mentioned, appears as bald patches and can be found at multiple locations on the scalp or body, or just in one place.

The patches can also differ in size and may come and go with time. Some people may just get a small bald spot that later disappears and never returns, for others it may differ in severity and the hair may grow back only to fall out again in another spot. Alopecia areata appears to affect all races and nationalities and both of the sexes to an equal extent and it can start at any age, though it most commonly manifests itself in people between the ages of 15-30. About 0.1-0.2% of the population are affected by this condition and there is currently no cure.

In this Italian study they examined how topical squaric acid dibutylester (SADBE) may improve alopecia areata and prevent it from recurring with full force. SADBE is a non-mutagenic contact sensitizer, it cause an allergic reaction and inflammation where itís applied and with continued application this has shown to cause regrowth of hair in alopecia areata patients. Itís normally dissolved in acetone upon application.

Patients with severe alopecia areata who received SADBE treatment were compared with areata patients who didnít receive any treatment at all. The reason why they used patients with severe alopecia areata is probably because patients with a less than severe condition may regrow their hair naturally and not have any relapses, which makes it harder to estimate the efficacy of the treatment.

The SADBE patients improved their condition compared to the untreated patients and even though there were no significant differences in relapse between the two groups, the treated patients had less severe relapses. 44% vs 52% may seem like a significant difference but the number of patients in the study is too low for it to be statistically significant. This is because doctors canít ruled out that it may just be a coincidence.

The study concludes that SADBE treatment does indeed help to lessen the severity of alopecia areata and its relapses, which is also supported by other studies. The best candidate seems to be someone with patchy as opposed to diffuse hairloss, who doesnít have a family history of autoimmune disease and with a milder condition. Possible side effects include eczema, swelling of lymph nodes, blistering and changed pigmentation of the skin.