Alopecia Areata Treated with Phenolisation and Intravenous Dexamethasone Pulses
A 13 year old girl presented to us with diffuse hair loss over the scalp involving more than 50% of the scalp [] for the past 6 months. She had consulted many dermatologists in the past 6 months since the onset of her complains, but none of the treatment brought relief. Therefore, it was not only the disease entity that we needed to consider but also the financial and psychosocial impact on the patient. She had no associated hair loss over any other body site. There was no history suggestive of any associated complaints. Her nails were normal on examination. There was no history of similar complains in the family. After taking a prior informed consent, phenolisation was done over the bald patches with 88% phenol until a uniform ivory white frost appeared. Phenol was applied all over the bald patches, covering more than 50% of scalp surface; 1 ml of phenol was taken in a container and applied to the scalp by dipping a bud in phenol. We assume that out of 1 ml, some amount of phenol was left in the bud. Thus, the total application of phenol was below the safe limit. No neutralization was done. The patient did complain of burning sensation and was given 5 mg diazepam orally. She underwent 5 such sittings at an interval of 15 days each. She was also given dexamethasone pulse therapy for 4 months. Dexamethasone was given in the dose of 60 mg intravenously in 5% dextrose. She was given dexamethasone and phenolisation at an interval of 15 days. She began to show response to therapy after the 2nd sitting when vellus hair regrowth was evident diffusely all over the bald patches. After five sessions done with 88% phenolisation and 4 pulses of dexamethasone intravenous therapy, she showed marked improvement with well-marked hair growth over the patches. Phenolisation is painful and therefore she was given intravenous diazepam prior to the procedure. There were no reported side effects in the present case.