Indian Journal of Dermatology, Venereology and Leprology Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) ISSN: 0378-6323 EISSN: 0973-3922 Vol. 75, Num. 5, 2009, pp. 513-514

Indian Journal of Dermatology, Venereology and Leprology, Vol. 75, No. 5, September-October, 2009, pp. 513-514

Letter to the Editor

Topical immunotherapy with dinitro-chlorobenzene: Safety concerns

Gurcharan Singh, M. S. Lavanya

Department of Dermatology and STD, Sri Devaraj Urs Medical College, Tamaka, Kolar - 563 101, India

Correspondence Address: Dr. Gurcharan Singh, 108, A, Jal Vayu Vihar, Kamanahalli, Bangalore - 560 043, India
gsdrsingh@gmail.com

Code Number: dv09164

PMID: 19736437

DOI: 10.4103/0378-6323.55402

Sir,

We read with ardent interest the letter to the editor by Mohan et al . in a recent issue of IJDVL. ^[1] However, we would like to express our strong reservations about the usage of dinitrochlorobenzene (DNCB) despite its observed efficacy in view of the safety issues associated with it.

As established beyond doubt several years ago, DNCB is an inherently mutagenic compound. ^[2] Its mutagenicity was demonstrated at all concentrations in the Salmonella typhimurium plate assay. ^[3],[4] The assay is an invaluable screening test with a high qualitative correlation (90%) between mutagenesis and carcinogenesis. ^[3]

In addition, DNCB depletes the activity of glutathione S transferase in rat skin, blocking an important detoxification system of mammalian cells, ^[5] and is found to be genotoxic by sister chromatid exchange in human skin fibroblasts. ^[6] Moreover, DNCB has a significant systemic absorption. ^[7]

All the significant trials concerning DNCB have been performed before the year 1990 and there has been a steady decline in enthusiasm and publications on the use of DNCB in benign disorders of the skin after the discovery of its mutagenic potential. Therefore, in view of the possible risks involved with DNCB and the availability of newer alternative potent contact allergens, the use of DNCB to treat benign skin diseases is to be abandoned until proper carcinogenicity tests are conducted and the question of its hazard is resolved. ^[8]

References

1.	Mohan KH, Balachandran C, Shenoi SD, Rao R, Sripathi H, Prabhu S. Topical Dinitrochlorobenzene (DNCB) for alopecia areata: Revisited. Indian J Dermatol Venereol Leprol 2008;74:401-2.   Back to cited text no. 1  [PUBMED]
2.	Wilkerson MG, Connor TH, Wilkin JK. Dinitrochlorobenzene is inherently mutagenic in the presence of trace mutagenic contaminants. Arch Dermatol 1988;124:396-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.	Black HS, Castrow FF, Gerguis J. The mutagenicity of dinitrochlorobenzene. Arch Dermatol 1985;121:348-9.  Back to cited text no. 3
4.	Macdonald Hull SP, Wood ML, Hutchison PE, Sladden M, Messanger AG. British Association of Dermatologists. Guide lines for the management of alopecia areata. Br J Dermatol 2003;149:692-9.   Back to cited text no. 4
5.	Rokhsar CK, Shupack JL, Vafai JJ, Washenik K. Efficacy of topical sensitizers in the treatment of alopecia areata. J Am Acad Dermatol 1998;39:751-61.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.	Deleve LD. Dinitrochlorobenzene is genotoxic by sister chromatid exchange in human skin fibroblasts. Mutation Res 1996;371:105-8.  Back to cited text no. 6  [PUBMED]
7.	Harrison S, Sinclair R. Optimal management of hair loss( alopecia) in Children. Am J Clin Dermatol 2003;4:757-70.  Back to cited text no. 7  [PUBMED]
8.	Happle R. The potential hazards of dinitrochlorobenzene. Arch Dermatol 1985;121:330-2.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]

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