Alopecia universalis

Alopecia universalis (AU) or alopecia areata universalis is a medical condition involving loss of all hair, including eyebrows and eyelashes. It is an advanced form of alopecia areata.[1]

Alopecia universalis
Person with alopecia universalis


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 approximately 20% of those affected have a family member with alopecia.[2][1]


There is no standard treatment for alopecia universalis. Many treatments have been explored, including immunomodulatory agents such as imiquimod.[3] Tofacitinib citrate may also have benefits. In June 2014, it was reported that a 25-year-old man with almost no hair on his body grew a full head of hair, as well as eyebrows, eyelashes, facial, armpit and other hair, following eight months of treatment.[4]

Current Medical Treatments

  • Contact Immunotherapy: Contact immunotherapy involves the use of contact allergens, such as diphencyprone (DPCP) and squaric acid dibutylester (SADBE), to induce an immune response that is thought to oppose the action of cells causing hair loss.[5][6][7] A review that combined and analyzed the findings of 45 studies comprising 2,227 patients showed any hair regrowth in 54.5% and complete hair regrowth in 24.9% of patients with AT and AU using contact immunotherapy.[8] In addition to its helpful effects in treating AU, it can have side effects that can be very serious, like severe dermatitis.[5][9]
  • Corticosteroids: Topical and intralesional corticosteroids, such as clobetasol proprionate, have also shown to be an effective treatment for AT and AU patients.[5][6] A controlled study comprising 28 patients found positive terminal hair growth in 8 of the patients (28.5%) using a 0.05% clobetasol propionate ointment.[10] This is very similar to the results obtained from immunotherapy treatment trials. Additionally, studies suggest that intralesional applications are much more effective than topical applications of steroids. However, the main side effect is increased risk of cutaneous atrophy at the site of treatment;[6] folliculitis is also an occasional complication.[7]

Investigational and Future Medical Treatments

  • JAK Inhibitors: Janus kinase (JAK) inhibitors, previously used in the treatment of cancer and other diseases, such as arthritis, have successfully shown to be effective in the initial trials of treatment for alopecia patients.[5][6][11] There have been multiple cases of successful treatments, one of them being of a 22-year-old man with a history of AU and atopic dermatitis (AD). This man was treated with JAK inhibitor tofacitinib, and after 10 months he experienced hair regrowth on all of his affected body parts and subsequent improvement of his AD.[12][13] Current research and findings suggest that systemic JAK inhibitors eliminate and prevent the development of AA, while topical JAK inhibitors promote hair regrowth and reverse the established disease.[7][14] Many clinical trials are ongoing involving JAK inhibitors such as ruxolitinib and tofacitinib.[5][15]

See also


  1. "Alopecia universalis | Disease | Overview | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". Retrieved 2016-03-01.
  2. Robins DN (2007). "Case reports: alopecia universalis: hair growth following initiation of simvastatin and ezetimibe therapy". Journal of Drugs in Dermatology. 6 (9): 946–7. PMID 17941369.
  3. Letada PR, Sparling JD, Norwood C (2007). "Imiquimod in the treatment of alopecia universalis". Cutis; Cutaneous Medicine for the Practitioner. 79 (2): 138–40. PMID 17388216.
  4. "Hairless Man Grows Full Head Of Hair In Yale Arthritis Drug Trial". 2014-06-19.
  5. Khan Mohammad Beigi, Pooya (2018), Khan Mohammad Beigi, Pooya (ed.), "Alopecia Totalis/Universalis", Alopecia Areata: A Clinician's Guide, Springer International Publishing, pp. 13–15, doi:10.1007/978-3-319-72134-7_3, ISBN 9783319721347
  6. Darwin, Evan; Hirt, PenelopeA; Fertig, Raymond; Doliner, Brett; Delcanto, Gina; Jimenez, JoaquinJ (2018). "Alopecia areata: Review of epidemiology, clinical features, pathogenesis, and new treatment options". International Journal of Trichology. 10 (2): 51–60. doi:10.4103/ijt.ijt_99_17. ISSN 0974-7753. PMC 5939003. PMID 29769777.
  7. Pratt, C. Herbert; King, Lloyd E.; Messenger, Andrew G.; Christiano, Angela M.; Sundberg, John P. (2017-03-16). "Alopecia areata". Nature Reviews Disease Primers. 3: 17011. doi:10.1038/nrdp.2017.11. ISSN 2056-676X. PMC 5573125.
  8. Lee, Won-Soo; Lee, Young Bin; Kim, Beom Jun; Lee, Solam (2018-10-01). "Hair Regrowth Outcomes of Contact Immunotherapy for Patients With Alopecia Areata: A Systematic Review and Meta-analysis". JAMA Dermatology. 154 (10): 1145–1151. doi:10.1001/jamadermatol.2018.2312. ISSN 2168-6068. PMC 6233743. PMID 30073292.
  9. Strazzulla, Lauren C.; Wang, Eddy Hsi Chun; Avila, Lorena; Lo Sicco, Kristen; Brinster, Nooshin; Christiano, Angela M.; Shapiro, Jerry (January 2018). "Alopecia areata: An appraisal of new treatment approaches and overview of current therapies". Journal of the American Academy of Dermatology. 78 (1): 15–24. doi:10.1016/j.jaad.2017.04.1142. ISSN 1097-6787. PMID 29241773.
  10. Tosti, Antonella; Piraccini, Bianca Maria; Pazzaglia, Massimiliano; Vincenzi, Colombina (July 2003). "Clobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis". Journal of the American Academy of Dermatology. 49 (1): 96–98. doi:10.1067/mjd.2003.423. ISSN 0190-9622. PMID 12833016.
  11. Clynes, Raphael; Christiano, Angela M.; Vaughan, Roger; Furniss, Megan; Ulerio, Grace; Clark, Charlotte; Cerise, Jane E.; Nguyen, Nhan; Jabbari, Ali (2016-09-22). "Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata". JCI Insight. 1 (15): e89790. doi:10.1172/jci.insight.89790. ISSN 0021-9738. PMC 5033756. PMID 27699253.
  12. Morris, Gabriela M.; Nahmias, Zachary P.; Kim, Brian S. (2018-07-01). "Simultaneous improvement of alopecia universalis and atopic dermatitis in a patient treated with a JAK inhibitor". JAAD Case Reports. 4 (6): 515–517. doi:10.1016/j.jdcr.2017.12.016. ISSN 2352-5126. PMC 6047104. PMID 30023415.
  13. Navarini, Alexander A.; French, Lars E.; Trüeb, Ralph M.; Kamarachev, Jivko; Maul, Julia-Tatjana; Anzengruber, Florian (2016). "Transient Efficacy of Tofacitinib in Alopecia Areata Universalis". Case Reports in Dermatology. 8 (1): 102–106. doi:10.1159/000445182. ISSN 1662-6567. PMC 4869306. PMID 27194979.
  14. Clynes, Raphael; Christiano, Angela M.; Mackay-Wiggan, Julian; Petukhova, Lynn; Singh, Pallavi; Rothman, Lisa; DeStefano, Gina M.; Harel, Sivan; Jong, Annemieke de (September 2014). "Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition". Nature Medicine. 20 (9): 1043–1049. doi:10.1038/nm.3645. ISSN 1546-170X. PMC 4362521. PMID 25129481.
  15. Craiglow, Brittany G.; King, Brett A. (December 2014). "Killing Two Birds with One Stone: Oral Tofacitinib Reverses Alopecia Universalis in a Patient with Plaque Psoriasis". Journal of Investigative Dermatology. 134 (12): 2988–2990. doi:10.1038/jid.2014.260. ISSN 0022-202X. PMID 24940651.
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