Squaric Acid Alopecia Treatment


Squaric Acid Dibutyl Ester (SADBE), also called quadratic acid, earns its name because its four carbon atoms form a square. Squaric Acid is an organic compound with chemical formula C4H2O4.

That’s probably enough chemistry talk for now. What’s important is how Squaric Acid alopecia areata treatments are applied, whether or not they work, and if there are side effects.

Squaric acid is a liquid chemical that is applied to the scalp of patients suffering from hair loss. It is one of three major contact sensitizers which are in use for alopecia areata therapy. The other two major contact sensitizers include dinitrochlorobenzene (DNCB) and diphencyprone (DPCP). Contact sensitizers like Squaric Acid are used to cause irritation and an allergic reaction on the hair loss sufferer’s scalp. The reaction seems to “trick” the immune system into sending a response to attack the chemical rather than attacking the patient’s own hair. The redirection of the immune system’s assault gives the hair a chance to begin re-growing.


Before beginning a Squaric Acid hair loss treatment doctors will first rule out hormonal and other causes of hair loss. There should also be a conversation between you and your doctor about possible side effects. Only after you and your doctor agree should treatment proceed.

Squaric Acid Alopecia Treatment – Step 1

The first step is to use a sensitivity patch to gauge your sensitivity to Squaric Acid. The purpose of the test is to determine the concentration of Squaric Acid that elicits an adequate reaction without causing severe discomfort. Your sensitivity level will determine the concentration of the Squaric Acid alopecia treatment. The doctor should apply Squaric Acid at a 2% concentration to 1 inch by 1 inch area on inside of upper arm. An outline of the area should be drawn with a marker before applying the Squaric Acid. Once the sensitivity patch has been applied, cover the area with Vaseline and a Band-Aid. Make sure the sensitivity test area is not washed for 24 hours. After that period the Band-Aid should be removed. You should return to see the doctor in 2-3 weeks. You may can be sent home with a topical steroid that you can apply if there is a negative reaction.

Squaric Acid Alopecia Treatment – Step 2

The next step in Squaric Acid alopecia treatment is to examine your reaction to the first sensitivity test. If you do not experience a reaction at the site of sensitivity test then the doctor will increase the concentration of the Squaric Acid. The doctor can increase the concentration to different degrees on left arm and on right arm to expedite the process of finding the right concentration level. Continue increasing concentration by power until patient experiences a reaction of redness, scaling, and itching which should last 24-36 hours. The reaction may be uncomfortable but should still be tolerable at the right concentration level.

Squaric Acid Alopecia Treatment – Step 3

The third step of Squaric Acid alopecia treatment is to finally treat the scalp. The Squaric Acid solution is applied with cotton swabs to moisten the areas affected by hair loss. It isn’t necessary to cover every square inch. The point is to stimulate the scalp. Your doctor will provide you with home instructions to apply the Squaric Acid treatment several times per week, typically at night. Always use gloves when applying the Squaric Acid. Over time you may increase the frequency of application of the medication as instructed by your doctor. The increases in concentration and frequency will be entirely dependent upon your response to treatment.

You should return to see you doctor again the following month. At that point the doctor will be looking for any new hair. If the doctor does not see any hair regrowth then the concentration of the medication may be increased further. If the increase in concentration causes burning and blistering the dosage will be reduced again. If you have good regrowth then treatment may continue with the same concentration level. Treatment will continue until it is no longer needed.

Do SQUARIC ACID Alopecia Treatments Work?

The median response rate is 43%. The success rate of Squaric Acid alopecia treatments compare well with other therapies. Success rates with regards to the use of Squaric Acid alopecia treatments vary. The variation in success rates is due in part to the parameters of what is acceptable successful hair re-growth from study to study. There are three factors that are found to be of negative prognostic significance. The extensiveness of hair loss prior to treatment, length of time of alopecia areata prior to treatment, and the observation of changes in the nails are of negative prognostic significance.

Squaric Acid Alopecia Treatment Side Effects

The use of contact sensitizers like Squaric Acid has one inherent disadvantage. They typically produce likely to produce a vigorous allergic response. After all – that’s what they are designed to do. Some of the side effects include:

• Tiny blisters
• Pruritis or severe itching
• Severe contact dermatitis
• Abnormal enlargement of the lymph nodes
• Erythema or redness of the skin
• Vitiligo or leukoderma

If broken skin occurs at the site of application stop the therapy immediately and contact your doctor. Your doctor will prescribe a strong cortisone cream to stop the irritation. You should use it twice a day until the irritation disappears. Once the irritation disappear restart the therapy at the previous interval. It’s important to keep in mind that some redness is necessary. However, we do not want broken skin or infection.

Sleep disturbances secondary to the pruritis have also been reported. Less common side effects include urticaria (hives), erythema (redness), vitiligo (commonly known as leukoderma), arthralgia (severe joint pain), and fever. “Dyschromia in confetti” -like lesions of hypo (excessive) and hyper (diminished) pigmentation may occur.

Apart from these listed side effects, no long-term side effects have been reported after 21 years of SADBE treatment worldwide.

Call your doctor for medical advice about side effects. In the US you may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada you may report side effects to Health Canada at 1-866-234-2345.

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