alopecia areata can affect any hair - bearing area . it is a lymphocyte cell - mediated inflammatory type of hair loss , although the exact pathogenesis is unclear .
phenol , also known as carbolic acid , is well known as an antiseptic agent .
it is a bactericide ( > 1% ) , fungicide ( > 1.3% ) , and a local anaesthetic . at concentrations over 80% , phenol coagulates proteins .
pertaining to its easy availability and affordability , it finds great usefulness in being used in many office procedures in dermatology clinics .
the mechanism of action is based on its irritating property that leads to tissue necrosis .
phenol has the property of penetrating into the layers of skin , and this is inversely proportional to its concentration .
the application of pure , undiluted 88% phenol to the skin causes rapid and complete coagulation of epidermal keratin protein and produces a partial blockade for further chemical penetration .
the more dilute solution of 50% has greater penetration and , thus , peel potency than the full strength of 88% straight phenol preparation .
there is a risk of systemic absorption leading to toxicity that can be averted by dividing the desired area into small areas and using a gap of 15 min while applying phenol to each of the affected areas .
a 13 year old girl presented to us with diffuse hair loss over the scalp involving more than 50% of the scalp [ figure 1 ] 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 .
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 .
she began to show response to therapy after the 2 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 .
phenol has been used for the treatment of various conditions like vitiligo , molluscum contagiosum , epidermal cysts , acne scars , and facial rejuvenation .
the mechanism by which phenol acts in alopecia areata is unclear ; however , various mechanisms have been proposed such as the release of various growth factors during the wound repair process that stimulate the follicles . also , various cytokines released during wound healing neutralise the peribulbar infiltrates , causing re - growth of hair through immunomodulation .
lastly most of the follicles in alopecia areata are in the telogen phase and thus lie in the dermis . therefore , it is proposed that phenol passes through the follicular opening and directly stimulates the germinal centre .
alopecia areata is an organ - specific autoimmune disease directed against various cellular components of hair follicles , thus dexamethasone pulse has a profound but transient action on the perifollicular lymphocytes that restores normal hair cycle .
use of phenol in the concentration of 20% alone or in combination with oral mini pulse with betamethasone or 2% minoxidil has been reported previously , and it was reported that combination therapy is better than use of single agent .
this could probably be because concentration of phenol used was low as compared to that in this study .
the rationale for combining phenol and dexa pulse is to get a fast and better result .
the patient has shown marked improvement with 5 sessions of phenol and 4 monthly pulses of dexamethasone over a period of 4 months and has not shown any relapse even after 6 months of follow - up . keeping the safe limit in consideration ,
 phenol is an aromatic hydrocarbon derived from coal tar or manufactured from monochlorobenzene . 
 alopecia areata is a common non scarring autoimmune condition characterised by patchy loss of hair without atrophy . 
 various treatment modalities have been proposed and used for the treatment of alopecia areata , which is indeed a difficult condition to treat . 
 variable results have been documented using intralesional corticosteroid injections , topical minoxidil , topical anthralin ointment , topical contact sensitizers like diphencyprone , dinitrochlorobenzene or squaric acid dibutyl ester , and oral mini pulse with betamethasone . 
 the use of 88% phenol for the treatment of alopecia areata has been documented in literature , but it has failed to secure a place in the priority list . herein we have reported a case of a young girl who was treated with short - time aggressive therapy using 88% phenol and dexamethasone pulse therapy and who responded well to the treatment with no recurrence in the last 6 months of follow - up . 
INTRODUCTION
CASE REPORT
DISCUSSION