Dermatology - Dithranol (Dithocream) Treatment for Alopecia Areata

What is Dithranol treatment?

Dithranol is a licensed cream originally used to treat the skin condition psoriasis. It is a chemical made from tree bark. In addition to its use in psoriasis, it is known to cause skin irritation when applied to normal skin.

How does Dithranol work in alopecia areata?

It is these irritant effects when applied to the scalp skin that are useful in treating alopecia areata. It appears to work by “distracting” your immune system away from attacking the hair roots by causing irritation and inflammation on the scalp skin surface. However, the exact way it works is not fully understood.

Who can have Dithranol treatment?

At Salford Royal Hospital, people are considered eligible for dithranol treatment if they have scalp alopecia areata. Dithranol is a safe option for children and can also be used in pregnancy.

What have I been prescribed?

You have been prescribed two strengths of Dithranol. These are 0.5% Dithrocream® (=purple 50g tube) and 1% Dithrocream® (=brown 50g tube):
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How do I use it?

The aim of treatment is to produce skin irritation (i.e. redness and itch) on your scalp for about twenty-four hours. If there is no skin irritation the treatment is unlikely to be successful.

If there is too much irritation, you will be uncomfortable. Unfortunately it is difficult to predict how each person will respond to this treatment (i.e. how much irritation will occur).

For this reason it is best to start slowly and gradually build-up the treatment over time. The way to do this is explained below:

• Start by thinly applying the lower strength dithranol (i.e. 0.5% Dithrocream®) to the bald areas on the scalp for twenty minutes. 

It is best to do this in the evening. Do not cover the scalp with hats, wigs, etc. during treatment

• Wash the treatment off after twenty minutes
• You should aim to repeat this process daily
• REMEMBER: You are aiming for twenty-four hours of itch and redness

After 2 weeks it is likely that the treatment will need some adjustment to get the correct amount of redness and itch.

This is done initially by increasing the time of application, and then, if necessary, the strength of treatment.

The following steps should be taken to reach the correct treatment level. Please only adjust the treatment every 2 weeks.

• First: Increase time of application (i.e. 20 mins → 40 mins → 60 mins (=maximum))
• Next (if needed): Increase the strength of treatment to 1% Dithranol and start again by applying the cream for 20 mins per day for 2 weeks. Again, slowly build up the treatment duration to a maximum of 60 mins/day

The aim is to maintain the skin irritation (itch and redness) for twenty-four hours. As your skin gets “used to” the treatment you may need to adjust the treatment again.

When you are at the correct level of redness and itch please continue at the same level (i.e. you don’t need to keep increasing the treatment after this point).

How long should I use it?

It can take a number of weeks before new hair growth is seen - so don’t give up too soon. If hair re-growth occurs it is important to continue the treatment until acceptable growth is achieved.

If no new hair growth has occurred after 6 months the treatment is usually stopped.

Does it work?

As with many treatments for alopecia areata dithranol has a relatively low success rate but it can be helpful in stimulating hair growth in some people.

Reports suggest about a 25% chance of cosmetically acceptable hair regrowth in those with extensive hair loss.

This re-growth rate is likely to be higher in those people with less hair loss.

Are there any other treatment options available?

Yes. There are a number of reported treatments for hair loss.

Feel free to discuss what alternative treatment options are available with your Consultant.

What are the side effects of dithranol treatment?

Dithranol stains the skin and light-coloured hair a purple/brown colour. If you wear a wig or hat regularly you should be able to hide this effect. The staining is not permanent and will gradually fade within a couple of weeks.
 
Dithranol may also stain clothing and bathroom furniture. Be careful to wash your sink/shower/bath after each use to prevent staining.

Dithranol is an irritant and so it will irritate any skin it comes into contact with. The treatment should only be used on the scalp. Wash your hands after each application and avoid contact with eyes.

You should also avoid excessive sunlight exposure to the scalp during a course of dithranol treatment.

Other side effects include skin spots (folliculitis) and enlargement of lymph glands in the neck.

What if I develop side effects that worry me?

Before starting treatment you will be given our contact details. You can contact us at any time during normal working hours to obtain advice or to organise an urgent review if necessary.

If you develop a worrying side effect over the weekend, you may need to seek medical advice from your local GP out of hours service.

If you are unwell and require urgent treatment you should attend your local Accident & Emergency department.

If you have problems or other unexplained symptoms, please contact the department.

Contact details

The Dermatology Centre Salford Royal Hospital Stott Lane
Salford M6 8HD
0161 206 9880