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What You Should Know About Alopecia Totalis

What is alopecia totalis?

Alopecia totalis is a skin condition that causes hair loss. It isn’t the same as localized alopecia areata. Localized alopecia areata causes round patches of hair loss on the scalp, but alopecia totalis causes complete baldness of the scalp.

Alopecia totalis is also different from the most severe form of alopecia areata, known as alopecia universalis. This form of alopecia causes complete hair loss over the entire body.

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Symptoms

Symptoms

The primary symptom of alopecia totalis is complete loss of all head hair. This form of alopecia can begin as alopecia areata. You may start off with small patches of hair loss. These patches spread over time until the entire head is bald.

Hair loss can begin suddenly and occur rapidly. If you have alopecia totalis, you may also have brittle, pitted nails.

Causes

Causes

Researchers and doctors aren’t yet able to pinpoint the exact cause of alopecia totalis, though it’s understand that the condition is the result of an immune system problem. Your immune system is your body’s defense mechanism that protects you from illnesses. But sometimes, the immune system attacks healthy tissue.

If you have any form of alopecia, your immune system attacks your hair follicles. This attack triggers inflammation, which leads to hair loss.

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Risk factors

Risk factors

It's unclear why a person develops an autoimmune disease, but some people have a higher risk of alopecia totalis. It can affect anyone, but it’s more common in children and adults younger than 40 years.

Some people may also have a genetic predisposition for alopecia. It’s not unusual for someone with alopecia totalis to have a family member diagnosed with alopecia.

Some doctors also suspect a connection between extreme stress and developing alopecia. Chronic stress can weaken the immune system and interfere with its ability to function properly.

Diagnosis

How it’s diagnosed

Alopecia is a type of skin disorder, so your doctor may refer you to a dermatologist for an accurate diagnosis. It’s a common condition, and some doctors can make a diagnosis based off of a visual exam alone.

Your doctor may conduct a physical examination of your head to check the pattern of hair loss. You may undergo further testing to confirm a diagnosis. This testing may include a scalp biopsy, in which a skin sample is removed from your scalp and sent to a lab. Your doctor may also perform blood work to help identify an autoimmune disease or an underlying problem that mimics alopecia, such as a thyroid disorder.

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Treatment

How to treat alopecia totalis

Once you're diagnosed, your doctor will determine the best course of action. Several therapies are effective for restoring hair loss.

Corticosteroids

Your doctor may prescribe a corticosteroid to suppress your immune system. This stops the immune system from attacking healthy tissue. As a result, you may notice less hair loss. You may begin to regrow hair in affected areas.

Topical immunotherapy

This treatment boosts your immune system to help your body fight the condition. If effective, this therapy can stimulate your hair follicles, resulting in new hair growth.

Minoxidil (Rogaine)

This hair growth treatment can be used by children and adults. For best results, use this medication in conjunction with other therapies. Hair may begin to regrow within three months.

Diphencyprone (DPCP)

DPCP is a topical treatment designed to stimulate an allergic reaction, which prompts an increase in white blood cell count. This response helps stimulate hair follicles and promotes hair growth.

Ultraviolet light therapy

This treatment increases blood circulation to hair follicles and stimulates hair growth. If you're able to regrow your hair, there’s still a risk of losing it again. Hair loss can recur once treatment ends.

Tofacitinib

This novel therapy, originally developed for rheumatoid arthritis, shows significant promise in treating the many forms of alopecia areata.

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Complications

Complications of alopecia totalis

Alopecia is unpredictable. While some people respond to treatment and regrow their hair, there's also the risk of alopecia totalis progressing. You could begin to lose hair on other parts of your body, including your eyebrows, legs, arms, nostrils, and groin area. This is known as alopecia universalis.

Early intervention and treatment of alopecia totalis reduces the likelihood of the condition getting worse.

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Outlook

Outlook

Alopecia totalis can be a permanent or a temporary condition. Because of the uncertainty of this skin disorder, there’s no way to predict your outcome. The odds of a positive outlook are higher the earlier you begin treatment.

Remember that you’re not alone. If you find that it’s difficult to cope with hair loss, join a local support group for solace and encouragement. You may also benefit from one-on-one counseling.

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