Alopecia universalis

Synonyms

Alopecia totalis, Alopecia areata universalis, AU,

Overview

Alopecia universalis is a condition characterized by the complete loss of hair on the scalp and body. It is an advanced form of alopecia areata, a condition that causes round patches of hair loss. Although the exact cause of AU is unknown, it is thought to be an autoimmune condition in which an affected person’s immune system mistakenly attacks the hair follicles. Roughly 20% of affected people have a family member with alopecia, suggesting that genetic factors may contribute to the development of AU. There is currently no cure for AU, but sometimes hair regrowth occurs on it’s own, even after many years. Alopecia universalis can occur at any age, and is currently believed to be an autoimmune disorder. 

Symptoms

Alopecia universalis is characterized by the complete loss of hair on both the scalp and body. Most people with AU do not have other signs and symptoms, but some may experience a burning sensation or itching on affected areas. In some cases, AU can be associated with other conditions such as atopic dermatitis, thyroid disorders, and/or nail changes (such as pitting). Anxiety, personality disorders, depression, and paranoid disorders are more common in people with different forms of alopecia areata.

  • Absence of body hair
  • Baldness
  • Absence of eyelashes
  • Absence of eyebrows
  • Total loss of scalp hair

Causes

The exact underlying cause of alopecia universalis is not currently known. AU is an advanced form of alopecia areata (AA), a condition that leads to round patches of hair loss. AA is thought to be an autoimmune condition in which an affected person’s immune system mistakenly attacks the hair follicles. Genetic studies have found that AA and AU are associated with several immune-related genes; however, they are likely complex disorders caused by the interaction of multiple genetic and environmental factors. This means that even if someone inherits a genetic predisposition to the condition, they may not become affected unless something in the environment triggers the onset of the condition. Stress is thought to be a contributor in AU. However, many with the disorder lead relatively-low stress lives.

Alopecia universalis is believed to be a multifactorial condition, which means it is caused by a combination of environmental influences and genetic predisposition. While a predisposition can be inherited and some affected people have a family history, the condition itself is not thought to be inherited.

 

Diagnosis

A diagnosis of alopecia universalis is usually based on the signs and symptoms present in each person. In rare cases, a scalp biopsy may be needed to confirm the diagnosis.

Prognosis

The course of alopecia universalis is highly unpredictable, and this uncertainty is one of the most difficult and frustrating aspect of the disease. Affected people may continue to lose hair, or hair loss may stop. Hair that has already been lost may or may not grow back.

Treatment

Although these is no therapy approved for the treatment of alopecia universalis, some people find that medications approved for other purposes may help hair grow back, at least temporarily. Since alopecia universalis is one of the more severe types of alopecia areata, treatment options are somewhat limited. The most common treatments include corticosteriods and topical (applied to to skin) immunotherapy.

There are possible side effects of corticosteriods which should be discussed with a physician. Also, regrown hair is likely to fall out when the corticosteriods are stopped. About 40% of people treated with topical immunotherapy will regrow scalp hair after about six months of treatment. Those who do successfully regrow scalp hair need to continue the treatment to maintain the hair regrowth.

While these treatments may promote hair growth, they do not prevent new loss or cure the underlying disease. For those who do not respond to treatment, wigs are an option.

Although, there is currently no cure for AU, but sometimes hair regrowth occurs on it’s own, even after many years.

Resources

  • NIH