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Alopecia Universalis: What You Should Know

What is alopecia universalis?

Alopecia universalis (AU) is a condition that causes hair loss.

This type of hair loss is unlike other forms of alopecia. AU causes complete hair loss on your scalp and body. AU is a type of alopecia areata. However, it differs from localized alopecia areata, which causes patches of hair loss, and alopecia totalis, which causes complete hair loss on the scalp only.

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Symptoms

Symptoms of alopecia universalis

If you begin to lose hair on your head and on different parts of your body, this is a key sign of AU. Symptoms include loss of:

  • body hair
  • eyebrows
  • scalp hair
  • eyelashes

Hair loss can also occur on your pubic area and inside your nose. You may not have other symptoms, although some people have itching or a burning feeling in affected areas.

Atopic dermatitis and nail pitting aren’t symptoms of this type of alopecia. But these two conditions can sometimes occur with alopecia areata. Atopic dermatitis is inflammation of the skin (eczema).

Causes

Causes and risk factors for alopecia universalis

The exact cause of AU is unknown. Doctors believe certain factors may increase the risk for this type of hair loss.

AU is an autoimmune disease. This is when the body’s immune system attacks its own cells. In the case of alopecia, the immune system mistakes hair follicles for an invader. The immune system attacks hair follicles as a defense mechanism, which triggers hair loss.

Why some people develop autoimmune diseases while others don’t isn’t clear. However, AU can run in families. If others in your family also develop this condition, there could be a genetic connection.

People with alopecia areata may have a higher risk for other autoimmune diseases, such as vitiligo and thyroid disease.

Stress may also trigger the onset of AU, although more research is needed to support this theory.

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Diagnosis

Diagnosing alopecia universalis

The signs of AU are distinct. Doctors can usually diagnose AU upon observing the pattern of hair loss. It’s a very smooth, nonscarring, extensive hair loss.

Sometimes, doctors order a scalp biopsy to confirm the condition. A scalp biopsy involves removing a sample of skin from your scalp and observing the sample under a microscope.

For an accurate diagnosis, your doctor may also perform blood work to rule out other conditions that cause hair loss, such as thyroid disease and lupus.

Treatment

Treatment for alopecia universalis

The goal of treatment is to slow or stop hair loss. In some cases, treatment can restore hair to affected areas. Because AU is a severe type of alopecia, success rates vary.

This condition is classified as an autoimmune disease, so your doctor may recommend corticosteroids to suppress your immune system. You may also be given topical treatments. Topical immunotherapies stimulate the immune system. Topical diphencyprone produces an allergic reaction to stimulate an immune system response. This is believed to redirect immune system response away from hair follicles. Both therapies help activate hair follicles and promote hair growth.

Your doctor may also suggest ultraviolet light therapy to promote blood circulation and activate hair follicles.

Tofacitinib (Xeljanz) appears highly effective for AU. However, this is considered off-label use of tofacitinib, which is approved by the U.S. Food and Drug Administration (FDA) for treating rheumatoid arthritis.

Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not been approved. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.

Learn more: All about off-label prescription drug use »

If treatment works, it can take up to six months to regrow hair in affected areas. But even when treatment is successful and hair regrows, hair loss may return once treatment stops.

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Complications

Complications of alopecia universalis

AU isn’t life-threatening. But living with this condition increases the risk of other health issues. Because AU causes baldness, there’s a higher risk for scalp burn from sun exposure. These sunburns increase the risk of developing skin cancer on your scalp. To protect yourself, apply sunscreen to bald spots on your head, or wear a hat or wig.

You may also lose your eyebrows or eyelashes, which makes it easier for debris to get into your eyes. Wear protective eyewear when outdoors or working around the house.

Because loss of nostril hair also makes it easier for bacteria and germs to enter your body, there’s a higher risk for respiratory illnesses. Protect yourself by limiting contact with sick people and talk to your doctor about getting an annual flu and pneumonia vaccination.

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Outlook

Outlook for alopecia universalis

The outlook for AU varies from person to person. Some people lose all of their hair and it never grows back, even with treatment. Others respond positively to treatment, and their hair grows back.

There’s no way to predict how your body will respond to treatment. If you have difficulty coping with alopecia unversalis, support is available. Talk to your doctor and get information on local support groups or look into counseling. Speaking and connecting with other people that have the condition or having one-on-one discussions with a professional therapist can help you manage your condition.

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