Study Evaluating Efficacy of Topical Squaric Acid Dibutyl Ester in Children and Adolescents With Alopecia Areata

The purpose of this study is to evaluate the efficacy and tolerability of squaric acid dibutylester (SADBE) in children and adolescents with alopecia areata (AA) and to evaluate effect of squaric acid dibutyl ester on patient-centered outcomes and payer relevant measures to assess treatment benefit from the patient perspective and to demonstrate value


Eligibility Criteria:
Inclusion Criteria:

* Evidence of a personally signed and dated informed consent document indicating that the participant or a legally acceptable representative/parent(s)/legal guardian has been informed of all pertinent aspects of the study.
* Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.
* not pregnant or breast feeding
* Participants who are women of child bearing potential(WOCBP) must agree to use one highly effective method of contraception(with a failure rate of \<1% per year during the intervention period and for at least 28 days after the last dose of study intervention.
* Negative highly sensitive pregnancy (urine) at the Day 1 visit before the first dose of study intervention for WOCBP
* Have a clinical diagnosis of AA with no other etiology of hair loss (e.g., telogen effluvium,androgenetic alopecia, etc.)
* greater than 10% hair loss of the scalp, including without evidence of terminal hair regrowth within 6 months at both screening and baseline visits
* Current episode of hair loss less than 5 years.
* must be on a stable regimen of permitted concomitant medication
* Must agree to avoid prolonged exposure to the sun and not to use tanning booths, sun lamps or other ultraviolet light sources in the treatment area during the study.

Exclusion Criteria:

* Other scalp disease that may impact AA assessment (e.g., scalp psoriasis, dermatitis, etc).
* Active systemic diseases that may cause hair loss (e.g., lupus erythematosus, thyroiditis, systemic sclerosis, lichen planus, etc).
* Any psychiatric condition including recent or active suicidal ideation or behavior
* Ongoing or recent history of any other uncontrolled and/or clinically significant medical or psychiatric disease or condition which, in the PI's medical opinion, should exclude participation in the study.
* Any present malignancies or history of malignancies with the exception of adequately treated or excised non metastatic basal cell or squamous cell cancer of the skin or cervical carcinoma in situ.
* History (single episode) of disseminated herpes zoster or disseminated herpes simplex, or a recurrent (more than one episode of) localized, dermatomal herpes zoster
* History of systemic infection requiring hospitalization, parenteral antimicrobial therapy, or as otherwise judged clinically significant by the investigator within 6 months prior to Day 1
* Known primary or secondary immunodeficiency disorder or a first-degree relative with a hereditary immunodeficiency
* Significant trauma or major surgery within 1 month of the first dose of study intervention.
* Considered in imminent need for surgery. Participants with elective surgery scheduled can only be enrolled in Study SADBE-high dose (HD) with the approval of the investigator.
* Active acute or chronic infection requiring treatment with oral antibiotics, antivirals, anti-parasitics, anti-protozoals, or antifungals within 4 weeks prior to Day 1 or any active systemic or local infection not meeting other exclusion criteria within 1 week prior to Day 1.
* Participant has a known hypersensitivity or previous allergic reaction to any of the active or inactive ingredients in the study intervention
* Anticipated treatment with prohibited concomitant medication(s) during the course of the study
* Received Herbal medications with either unknown properties or pharmaceutical properties that impact AA within 1 week of first dose of study intervention
* Received topical steroids (e.g., steroid cream, steroid ointment) on areas under assessment (i.e., scalp, eyebrows). within 2 week of first dose of study intervention
* Received Ultraviolet B (UVB) phototherapy, Psoralen Ultraviolet A (PUVA) therapy, other phototherapy, contact immunotherapy \[e.g.diphenylcyclopropenone (DPCP), and 1-chloro-2,4-dinitrobenzene (DNCB)\], topical irritants(e.g., anthralin), and liquid nitrogen cryotherapy within 4 weeks of first dose of study intervention
* Received Other topical or systemic treatments that could affect AA including: Immune suppressants (e.g., cyclosporine A, azathioprine, methotrexate (MTX), sulfasalazine, mycophenolate mofetil (MMF), everolimus, ibrutinib, Intralesional, topical, oral, or injectable (intramuscular or intraarticular)steroids or Oral or topical minoxidil within 8 weeks of first dose of study intervention or within 5 half-lives (if known), whichever is longer
* Received Any Janus kinase (JAK) inhibitor for use in any disease indication or other immunomodulatory biologic agents within 12 weeks of first dose of study intervention or 5 half-lives (if known), whichever is longer
* Investigator site staff members directly involved in the conduct of the study and their family members, site staff members otherwise supervised by the investigator, or participants who are University of Texas employees, including their family members, directly involved in the conduct of the study.
* Participants with shaved heads must not enter the study until hair has grown back to a reasonable level and is considered stable, in the opinion of the investigator.
* Have an active history of alcohol or substance abuse within 1 year prior to Day 1.
* Participant is unable to communicate or cooperate with the investigator due to language problems, poor mental development, or impaired cerebral function.