From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: Updated DNCB Treatment Instruction
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6168
Organization: unspecified
Date: Sat, 12 Sep 92 11:54:39 PDT

                     DNCB TREATMENT INSTRUCTIONS

DESCRIPTION 

DNCB (dinitrochlorobenzene) is a simple organic compound easily made by 
chemists. It is an unpatentable and inexpensive substance that is usually 
obtained in either bulk crystal form or liquid form (in an acetone base) from 
chemical supply houses. In industry, DNCB is used in the processing of color 
photography. It is also in use as an algicide in air conditioners and 
refrigeration equipment.

In past decades, researchers discovered dermatological uses for DNCB that 
involve direct application to the skin. In the process of exploring the 
dermatological applications of DNCB, researchers also discovered that DNCB has 
a very low toxic risk.

DOSAGE AND ADMINISTRATION 

For dermatological purposes, DNCB is currently available in four solution 
strengths, namely 10%, 2%, 0.2% and 0.02%. Each solution has an acetone base.

The stronger 10% solution is used initially in very small amounts to sensitize 
the body to DNCB. The weaker 2%, 0.2% and 0.02% solutions, which are applied 
using a cotton swab and accommodate differences in sensitivity, are intended 
for ongoing applications.

ACTION 

The mechanism of DNCB is similar to that of poison oak. Both produce a redness 
or itching of the skin indicative of contact dermatitis, as well as an 
underlying bodily effect.

ADVERSE REACTIONS  

Depending on the solution strength, DNCB may cause either a strong or mild 
form of contact dermatitis at the application site. The stronger, sensitizing 
10% solution may cause a more noticeable itchiness, tingling, burning or 
redness within hours of application. The weaker 2%, 0.2% and 0.02% solutions 
{cause a much milder skin reaction similar to the redness experienced from 
sunburn.

WARNINGS AND PRECAUTIONS 

1. Use only the 10% solution for sensitization unless a dermatologist 
   knowledgeable in contact sensitization recommends differently.

2. If severe contact dermatitis occurs, apply itch-reducing medicines 
   (e.g. calamine lotion) or Bactine directly to the rash. The use of 
   cortisone or hydrocortisone creams is not recommended for the itching.

3. If severe blistering occurs at an application site during sensitization,
   stop further applications and treat the blistering like any other minor 
   abrasion. Use Bactine or another topical antibacterial medication. Once the
   skin heals, resume applications using a lower concentration.

4. Avoid sunbathing or sustained exposure to the sun while using DNCB. 
   The absorption of the sun's rays by the skin may inhibit the intended 
   reaction.

5. Do not apply DNCB directly to any kind of topical skin disease or 
   disorder, such as Kaposi Sarcoma (KS) lesions.

6. If DNCB has been previously used or the skin exposed to DNCB (for 
   example, while developing color photography), do not use the 10% 
   solution for initial sensitization. Use the weaker 2% solution or 
   consult a dermatologist.

7. To avoid spreading the applied DNCB to other parts of the body, 
   completely cover the treated area with a bandage. When the bandage 
   is removed, immediately wash the treated area with soap and water.

8. To maintain the potency of the DNCB solution, keep the solution capped 
   with an air-tight cap, refrigerated, and away from sunlight.

DIRECTIONS FOR USE 

Using DNCB involves three distinct steps: Sensitization, Verification and 
Weekly treatment. Before beginning ongoing weekly treatments with DNCB, the 
body must first be sensitized to DNCB using the 10% solution. Then, four weeks 
later, verify sensitization by applying the 2% solution and checking for a 
specific bodily reaction (known as a reflare).

If sensitization is verified, start regular treatments the following week. If 
sensitization cannot be verified after one attempt, which is the case for some 
individuals, repeat sensitization with the 10% solution in increments of seven 
days until it occurs.

The information that follows describes each of the three steps and explains 
how to verify sensitization. These are very important and must be followed.

STEP I - SENSITIZATION 

Complete this step with the 10% solution before starting weekly treatments. If 
sensitization is effective, perform the following only once.

If you have previously used DNCB or have been exposed to DNCB start only with 
the 2% solution.

1. Saturate a cotton swab (Q tip) in the 10% DNCB solution and paint 
   an area approximately 2 inches in diameter.

2. When dry, saturate the cotton swab in the 10% DNCB solution and 
   repeat the previous operation.

3. Blow on the liquid to make the DNCB evaporate more quickly 

4. Cover the application site with an adhesive bandage (Band-Aid).

5. After 8-12 hours or overnight, remove the bandage and wash the 
   application site with soap and water.

STEP II - VERIFICATION 

The presence or absence of contact dermatitis is not a valid indicator that 
the body has been sensitized to DNCB. Therefore verify the underlying bodily 
sensitization as follows by applying the 2% DNCB solution four weeks  after 
applying the 10% DNCB solution.

1. Saturate a cotton swab (Q tip) in the 2% DNCB solution.

2. Paint a skin area approximately two inches in diameter with the swab.
   The underside of the forearms and the inside of the upper arms are best.

3. When the application site appears dry, paint the site again.

4. Cover the skin area with an adhesive bandage (a Band-Aid).

5. After 8-12 hours or overnight, remove the bandage and wash the 
   application site with soap and water.

6. Inspect the application site within 24 to 72 hours after applying 2% 
   DNCB solution. A typical reaction is a slight to moderate reddening, 
   itching or burning.

7. Inspect the original sensitization site where the 10% DNCB solution 
   was applied. The desired reaction--and proof of sensitization--is any 
   reddening of the original site. This reddening is a "reflare." (The 
   intensity of the reflare will be significantly less than the response 
   first achieved with the 10% DNCB solution.)

If sensitization is not achieved (that is, the original sensitization site 
does not reflare), repeat the sensitization process using the 10% solution one 
week after applying the 2% solution. Keep repeating the sensitization process 
in increments of seven days  with the 10% solution until reflare occurs.

Once reflare occurs, begin weekly treatments. It is not necessary to 
repeat verification with the 2% solution.

STEP III - WEEKLY TREATMENT 

One week after verifying sensitization in Step II, start ongoing treatments 
with the correct solution strength.

The correct solution strength is the weakest solution that causes any 
reddening, itching or burning sensations at an application site. Try the 2%, 
0.2% and 0.02% solutions to determine if one will produce such a skin 
reaction. Using a stronger solution than is required does not increase the 
effectiveness of the DNCB. On the contrary, ongoing use of an overly strong 
solution may increase discomfort and overstimulate the body. 

If the 2% solution does not result in reddening, itching or burning sensations 
at the application site, use the 10% solution weekly until the response is 
greater than appropriate. At that time start using the next weaker solution 
that results in an appropriate response. This may be necessary for individuals 
that are severely immunodepressed.

APPLY WEEKLY TREATMENTS AS FOLLOWS:

1. Saturate a cotton swab in the appropriate DNCB solution.

2. Paint a skin area approximately two inches in diameter with the swab.
   The underside of the forearms and the inside of the upper arms are best.

3. When the application site appears dry, paint the site again.

4. Cover the skin area with an adhesive bandage.

5. After 8-12 hours or overnight, remove the bandage and wash the application 
   site with soap and water.

6. Inspect the application site within 24 to 72 hours after applying the 
   DNCB solution. A typical reaction is a slight to moderate reddening, 
   itching or burning at the application site. This reaction is evidence of 
   the intended bodily response.

Repeat the application in increments of seven days  applying the DNCB to a 
different skin site each time. (After four to six weeks, or when normal skin 
color returns, reapply the DNCB to a previous application site.)

RECOMMENDATION

A collaborative relationship with your doctor or dermatologist is highly 
recommended when using DNCB. The Treatment Instructions must be followed 
exactly unless a dermatologist experienced in contact sensitivity recommends 
differently.