Alopecia universalis
Loss of all body hair with no other symptoms.
Alopecia universalis (AU), also called alopecia areata universalis, is the most severe form of alopecia areata. It causes the loss of all body hair—including eyebrows, eyelashes, chest hair, armpit hair, and pubic hair. People with AU are generally healthy, experience no other symptoms, and have a normal life expectancy.
The condition can appear at any age and is thought to be an autoimmune disorder, where the immune system attacks hair follicles. Genetics may play a role: about 20% of those affected have a family member with some form of alopecia.
No single treatment is universally accepted as both effective and worth the cost. Many approaches have been tried. Immunomodulatory drugs like imiquimod have been explored, and the JAK inhibitor tofacitinib has shown promise—for instance, in 2014, a 25-year-old man with nearly no body hair regrew a full head of hair plus eyebrows, eyelashes, and facial, armpit, and other hair after eight months of treatment. However, tofacitinib is expensive, has side effects, and its benefits stop when treatment stops.
Contact immunotherapy uses allergens such as diphencyprone or squaric acid dibutylester to trigger an immune response that may counter the cells causing hair loss. A review of 45 studies involving 2,227 patients found that 54.5% experienced some hair regrowth and 24.9% achieved complete regrowth in cases of alopecia totalis or universalis. Side effects can be severe, including serious dermatitis.
Topical and intralesional corticosteroids, like clobetasol propionate, have also been effective. In a controlled study of 28 patients, eight (28.5%) saw positive terminal hair growth using a 0.05% clobetasol propionate ointment—a rate similar to immunotherapy results. Intralesional applications appear more effective than topical ones, but the main side effect is an increased risk of skin thinning at the treatment site, with folliculitis as an occasional complication.
Janus kinase inhibitors, originally used for cancer and arthritis, have shown success in early trials for alopecia. For example, a 22-year-old man with AU and atopic dermatitis was treated with the JAK inhibitor tofacitinib; after ten months, he regrew hair on all affected areas and his dermatitis improved. Current research suggests systemic JAK inhibitors can prevent or stop alopecia areata, while topical versions promote regrowth and reverse established
- type
- Medical condition
- also known as
- Alopecia areata universalis
- severity
- Most severe form of alopecia areata
- symptoms
- Loss of all body hair; no other symptoms
- life expectancy
- Normal
- cause
- Believed to be an autoimmune disorder; genetic factors may contribute
- treatment
- No single accepted therapy; options include immunotherapy, corticosteroids, JAK inhibitors
Lore & Background
Alopecia universalis can occur at any age and is currently believed to be an autoimmune disorder, in which a person's immune system attacks the hair follicles. Genetic factors may contribute to AU, as about 20% of those affected have a family member with alopecia. Many treatments have been explored, including immunomodulatory agents such as imiquimod. Tofacitinib citrate may also have benefits. In one reported case, a 25-year-old man with almost no hair on his body grew a full head of hair, as well as eyebrows, eyelashes, and facial, armpit, and other hair, following eight months of treatment. However, there is no single accepted therapy that has systematically proven to be effective and for which the benefits would outweigh the costs.
Reader's Guide
Alopecia universalis represents the most severe form of alopecia areata, characterized by complete loss of body hair. Its significance lies in its autoimmune nature and the challenge of finding effective, lasting treatments. Contact immunotherapy, using allergens such as diphencyprone and squaric acid dibutylester, has shown any hair regrowth in 54.5% and complete regrowth in 24.9% of patients with alopecia totalis and universalis, though side effects can include severe dermatitis. Topical and intralesional corticosteroids, such as clobetasol propionate, have also shown effectiveness, with a controlled study finding positive terminal hair growth in 28.5% of patients. Janus kinase inhibitors, including tofacitinib and ruxolitinib, have shown promise in initial trials, with one case of a 22-year-old man experiencing regrowth after ten months. However, treatment effects often disappear with discontinuation, and costs and side effects remain significant barriers. The condition itself does not affect overall health or life expectancy.
Did You Know?
- About 20% of those affected have a family member with alopecia.
- A 25-year-old man grew a full head of hair after eight months of treatment with tofacitinib citrate.
- Contact immunotherapy showed complete hair regrowth in 24.9% of patients with alopecia totalis and universalis.
- Intralesional applications of corticosteroids are much more effective than topical applications.
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