Alopecia Universalis: Causes, Symptoms and Treatment RichFeel

Alopecia Universalis is a condition in which there is complete loss of hair on the scalp and also all over the body. Unlike other alopecia conditions that specifically affect  the scalp hair, Alopecia Universalis results in hair loss from scalp as well as other hear bearing regions of the body. Alopecia Universalis is thought to be a progression of alopecia areata that begins with round patches of hair loss on the scalp. About 1 to 2% people who develop alopecia areata show progression into Alopecia Universalis. The causes of Alopecia Universalis are not known, but it is thought to be an autoimmune disorder that occurs when body’s own immune system attacks hair follicles. Some experts also suspect involvement of environmental as well as genetic factors. Since hair loss is of non-scarring type hair re-growth may be possible in some cases. This article discusses the clinical features, aetiology and available treatment options for Alopecia Universalis. 

What is Alopecia Universalis?

Alopecia Universalis is characterised by complete loss of hair on the scalp as well as other parts of the body. It is an autoimmune disorder that is considered as a severe form of alopecia areata, which causes small patches of diffuse hair loss on the scalp. Alopecia areata can progresses into alopecia totalis that causes complete loss of scalp hair or into Alopecia Universalis which results in total hair loss from scalp and other body parts such as face, pubic region, underarms, chest, hand and legs. The hair follicle damage that leads to total hair loss seems to be mediated through inflammation. The inflammatory markers such as pathogenic T-cells, cytokine and chemokine are thought to infiltrate the hair follicle bulb leading to hair loss. Loss of complete body hair can be cause of psychological disturbances. Hence, people who suffer from Alopecia Universalis show a high prevalence of mood, anxiety and depressive disorders.

Alopecia Universalis can affect adults as well as children. As per one study Alopecia Universalis usually appears before the age of 30 years.

Causes of Alopecia Universalis

The exact cause of Alopecia Universalis is not known yet. However, since it is a progression of alopecia areata, Alopecia Universalis too seems to have strongest association with autoimmunity.  Its association with other autoimmune disorders such as vitiligo, lichen planus, morphea, atopic dermatitis, and diabetes mellitus confirms that Alopecia Universalis may be caused when body’s immune system mistakenly attacks the healthy hair follicles considering them as an antigen. Interestingly the targeted antigen is private to the hair follicle in case of Alopecia Universalis.

 Since the condition originates from alopecia areata it also seems to share the causative factors. Apart from autoimmunity, experts believe that Alopecia Universalis may also be caused due to genetic inheritance, factors such as viral infection or environmental triggers. Psychologic stress, anemia, parasitic infestations, hypothyroidism, hyperthyroidism and diabetes are considered as other offenders that increase the risk of alopecia areata that may progress to Alopecia Universalis.

In some cases Alopecia Universalis may result as an adverse side effect of medical treatment such as chemotherapy or treatment for multiple sclerosis. 

Common causes of Alopecia Universalis include,

  • Autoimmune response that attacks healthy hair follicles
  • Genetic factors causing inheritance of disease
  • Environmental and psychological triggers such as trauma , viral infection or stress
  • Other autoimmune disorder such as dermatitis, vitiligo, lichen planus
  • Adverse effect after treatment of multiple sclerosis

Symptoms of Alopecia Universalis

Loss of hair on scalp causing total baldness is the most prominent sign of Alopecia Universalis. However, in Alopecia Universalis there is loss of hair on other body parts too. Loss of body hair differentiates Alopecia Universalis from other alopecias. Apart from hair loss some people may have additional symptoms such as itching or burning on scalp, nail changes, and psychological disturbances.

Common symptoms of Alopecia Universalis include,

  • Loss of full scalp hair
  • Total baldness
  • Absence of eyebrows and eyelashes
  • Absence of body hair
  • Nail changes such as spaced pits on the surface of the nails

Can Alopecia Universalis be inherited?

Alopecia Universalis appears to be a multifactorial condition. This means it could be caused by autoimmune, genetic or environmental factors. Although the genes predisposition can be inherited and some people with Alopecia Universalis may have a family member with same condition, Alopecia Universalis is not thought to be inherited.

Diagnosing Alopecia Universalis

Diagnosing Alopecia Universalis is done based on careful examination of scalp skin and head. Doctor may ask for a complete medical history as Alopecia Universalis is also associated with some other autoimmune conditions. The symptoms of Alopecia Universalis are quite obvious and hence total baldness along with loss of full body hair is a clear indication of the condition. In some cases however, the skin histopathologic findings may be needed to confirm the diagnosis. Histopathologic feature of Alopecia Universalis include presence of peribulbar lymphocytic inflammation consisting mainly of T lymphocytes. The doctor may also perform some blood tests to confirm presence of autoimmune disorder.

Treatments of Alopecia Universalis

Treatment of Alopecia Universalis needs to address both psychological as well as physical symptoms caused by the condition. Although several treatments have been proposed clinically they have shown variable results, limited efficacy, and adverse effects. The treatment of Alopecia Universalis is therefore challenging. However some of the available treatment options used are,

  • Topical corticosteroids
  • Immunotherapy
  • Systemic corticosteroids
  • Immunosuppressants
  • Psoralen plus ultraviolet
  • Photo chemotherapy

Since total baldness can cause mental distress, camouflaging the baldness using a hair wig is the best option. Some professional hair clinic also design individually tailored hair system that fit perfectly and give a natural look.

Prognosis of Alopecia Universalis

Prognosis of Alopecia Universalis is quite uncertain. In some cases the hair regrows after a few years without any treatment where as some cases do not show any sign of hair regrowth even after rigorous treatment. Full recovery with hair re-growth is estimated in only about 10% of patients. Since total loss of scalp as well as body hair can be psychologically disturbing, joining a support group or going through counselling is a way to cope up with the condition.

 

Complications of Alopecia Universalis

The complications of Alopecia Universalis begin with its autoimmune origin. The treatment of alopecia areata is a challenging task as there is an involvement of several causative and risk factors. Even after treatment some people with Alopecia Universalis do not have hair-growth. The chances of hair regrowth are unpredictable and the chances of full recovery are seen in only 10% of patients.

Is There a Cure for Alopecia Universalis?

Alopecia Universalis does not have a definitive cure. However some therapies such as immunosuppressant agents, oral and topical corticosteroids, and phototherapy seem to be promising.

Fast facts on Alopecia Universalis

  • Alopecia Universalis is primarily considered as an autoimmune disorder. However, it may also be caused due to genetic factors and environmental triggers
  • Alopecia Universalis results in complete loss of scalp as well as full body hair
  • It is a progression of alopecia areata that begins with round patches of hair loss on the scalp
  • Alopecia Universalis can result in mood disorders, anxiety, depression and other psychological disturbances
  • Full recovery with hair re-growth is estimated in only 10% of people

Statistics of Alopecia Universalis

There are very limited epidemiological studies done to report the incidence of Alopecia Universalis. As per European data, nearly 1 in 4000 people develops Alopecia Universalis. Some studies report that about 7% to 25% of people who have alopecia areata show development of alopecia totalis and Alopecia Universalis.