What is Alopecia Universalis?

Alopecia Universalis (AU) is a condition distinguished by the entire loss of hair on the body and scalp. It is a rarer form and advances type of alopecia areata, an ailment that produces round patches of hair loss. Although the exact cause of AU is not yet fully understood, it is considered to be an autoimmune condition in which the person’s immune system wrongly attacks and destroys their hair follicles. The interplay between environmental and genetic factors is thought to have a role in the condition’s onset. There is no known cure for AU, but occasionally hair regrowth can happen on its own, even after many years.

Symptoms
AU is described by the total loss of hair on both the scalp and body. Most people with AU do not have other symptoms and signs but some may encounter a burning or itching feeling. In some cases, AU can be linked with other conditions such as thyroid disorders, atopic dermatitis, and nail changes (such as pitting). Anxiety, depression, personality disorders, and paranoid disorders are conditions that show higher than the average prevalence in people with varied forms of alopecia areata.

Cause
The specific cause of AU is unknown. AU is an advanced type of alopecia areata (AA), a condition that leads to round patches of hair loss. The most widely believed hypothesis is that AA is an autoimmune condition in which a person’s immune system inadvisedly attacks the hair follicles.

While genetic researchers have discovered that AA and AU are linked with several immune-related genes, they are possibly triggered ultimately by the interaction of multiple hereditary and environmental factors. This suggests that even if a person inherits a genetic predisposition to the disease (susceptibility), they may not generate the condition unless something in the environment produces its onset. Nevertheless, the exact role of environmental factors is still to be discovered. Circumstances that may trigger the onset or recurrence of hair loss may comprise of a viral infection, hormonal changes, trauma, and physical or emotional stress

Inheritance
AU is thought to be a multifactorial condition, which implies it is likely caused by a combination of environmental triggers and genetic predisposition (susceptibility). While a predisposition can be received from their parents and some people with AU have a family history, the condition itself is not considered to be inherited.

Diagnosis
A diagnosis of AU is ordinarily based on the symptoms and symptoms signal. In rare instances, a scalp biopsy may be required to confirm the diagnosis.

Treatment
No therapy has been found to control symptoms and signs for everyone who has alopecia universalis (AU) which makes managing AU a challenge. Although multiple treatments have been investigated, no therapy is currently approved by the United States Food and Drug Administration (FDA). Some promising therapies include:

  • diphenylcyclopropenone (DPCP)
  • photodynamic therapy
  • squaric acid dibutyl ester (SADBE)

Steroids
Combing dosage of cyclosporine with methylprednisolone (a steroid)
There are some current studies confirming that a class of medication identified as JAK inhibitors, which incorporates Ruxolitinib and tofacitinib, are useful in alopecia areata, including AU. However, JAK inhibitors have not yet been allowed by the FDA for use in skin conditions.

In some people with AU, hair regrowth occurs without treatment, sometimes after many years.

There are steps that can be exercised to decrease the possibility of getting too much sun and minimize other discomforts related to having no hair. These may include:

Using sunscreen on the face, scalp, and all areas of the skin exposed to the sun
Wearing eyeglasses or sunglasses to sheild the eyes from excessive sun and dust and debris when eyelashes or eyebrows are missing
Wearing caps, wigs,, or scarves to protect the scalp from the sun and retain head warmth
Utilizing an ointment within the nostrils to retain moisturize and help to defend against organisms overrunning the nose when nostril hair is missing
Many other approaches have been reported to have unsteady response rates in small studies in alopecia areata. These include nitrogen mustard, latanoprost, isoprinosine, massage and relaxation, aromatherapy, and acupuncture, among others.

Prognosis
The development of AU is very inconsistent, and this unpredictability is one of the most challenging and frustrating aspects of the condition. People with AU may continue to lose hair, or hair loss may stop. Hair that has already been gone may or may not grow back. It has been determined that only about 10% of patients experience a full recovery.

Statistics
According to Orphanet’s Report Series on the prevalence and incidence of rare diseases from 2017, the estimated prevalence of alopecia universalis, based on European data, is 25/100,000 people (which is approximately 1 in 4000 people). We are not knowledgeable of statistics specific to the United States.

To our knowledge, estimates of the number of people with alopecia areata who eventually develop alopecia Universalis or total range from 7% to 25%.