Introduction: Contact sensitizers remain the mainstay of treatment of alopecia areata totalis (AT). Systemic steroids in different regimes have been tried in AT with variable success. Many authors consider that addition of systemic steroids to the contact sensitizing protocol may mitigate the effect of the latter. However, there is scarcity of studies evaluating the response to combination therapy of systemic steroids with contact sensitizers. Case Summary: We report the case of a 19-year-old boy with AT of 5 years duration. Diphenylcyclopropenone (DPCP) was applied to right half of the scalp as per the standard protocol. With no response even after six months of this treatment, DPCP application was stopped and oral betamethasone pulse at the dose of 0.1 mg /kg weekly was started. Within 4 weeks of Betamethasone pulse, new hair growth was visible only on the right half of the scalp. DPCP was re-instituted on the same side of the scalp along with continuation of systemic steroids. Left half of the scalp served as control. At 8 weeks, DPCP treated side showed excellent growth while the left side responded poorly. Conclusion: This singular split scalp treatment outcome suggests that the response of contact sensitizers like DPCP is not suppressed by systemic corticosteroids; rather seems to have a synergistic effect in the treatment of AT.

Keywords: Alopecia Totalis; Areata; Diphenylcyclopropenone; Oral Minipulse; Steroid.