OVERVIEW

What is alopecia universalis?

Alopecia universalis is a type of hair loss disorder with unknown causes, characterized by the complete loss of all body hair, including scalp hair, eyebrows, eyelashes, beard, armpit hair, pubic hair, and vellus hair. Some patients may also experience nail changes.

Alopecia universalis cannot be completely cured, and current drug treatments show limited effectiveness. Combination therapies are often required. During the illness, hair loss can cause psychological stress and severely impact the patient's quality of life.

What is the difference between alopecia totalis and alopecia universalis?

Generally, both alopecia totalis and alopecia universalis are severe forms of alopecia areata, representing its most advanced stages. About 5%–10% of alopecia areata cases may progressively or rapidly develop into alopecia totalis or alopecia universalis.

Alopecia totalis refers to the complete or near-complete loss of scalp hair. In more severe cases, when hair loss extends to other body areas—such as eyebrows, beard, armpit hair, pubic hair, and even body hair—it is referred to as alopecia universalis.

Which groups are most commonly affected by alopecia universalis?

This condition predominantly occurs in adolescents and can affect both genders. Cases of alopecia universalis in children are particularly difficult to treat and have a high recurrence rate.

SYMPTOMS

What are the common manifestations of alopecia universalis?

• Progressive stage: Patients develop clearly defined round or oval patches of hair loss on the scalp. The affected scalp appears normal, usually without discomfort, though occasional itching or pain may occur. The skin in the bald areas feels soft to the touch. As the patches expand, hair at the edges becomes loose and easily pulled out. Hair across the body (eyebrows, eyelashes, etc.) may fall out within days to weeks. Eyelash loss can cause eye irritation or a foreign body sensation. Nail abnormalities are often present.

• Stationary stage: Hair at the edges of the bald patches no longer loosens, and the scalp remains soft to the touch. This phase may persist for months or years.

• Recovery stage: The scalp becomes firmer with a fine granular texture. New hair growth begins, initially appearing as fine, light-colored fuzz, followed by darker, thicker strands that gradually return to normal.

How does alopecia universalis progress?

Alopecia universalis is typically discovered due to patches of hair loss on the scalp. The condition progresses rapidly, with body hair (eyebrows, eyelashes, etc.) falling out within days to weeks, leading to universal hair loss. Subsequently, the disease progresses slowly, and a small percentage of cases may improve with treatment.

What complications can alopecia universalis cause?

Nail changes: Reported nail abnormalities occur in 7%–66% of cases, with pitting being the most common. Other frequent nail changes include thinning or thickening, red lunulae, and spoon-shaped nails.

CAUSES

What is the cause of alopecia universalis?

The exact cause of alopecia universalis remains unclear. It is a hair loss disorder influenced by multiple factors, including genetics, psychological stress, infections, vaccinations, and abnormal glucocorticoid levels. Current research primarily suggests it is an immune-mediated disease involving cellular immunity and the subsequent production of autoantibodies.

Is alopecia universalis contagious?

No, it is not contagious.

Is alopecia universalis hereditary?

It is currently unknown whether it has a hereditary component.

DIAGNOSIS

How is alopecia universalis diagnosed?

Doctors primarily diagnose it based on the patient's signs and symptoms, including complete hair loss (scalp, eyebrows, eyelashes, pubic hair, and body vellus hair), normal-appearing skin in bald areas, and a positive hair pull test during the active phase.

What tests are needed when alopecia universalis is suspected?

Patients are typically advised to undergo hematological tests to identify the cause of hair loss, including:

• Complete blood count (CBC): Mainly to check for anemia;

• Trace elements and ferritin: To assess iron deficiency;

• Humoral immunity tests, antinuclear antibody profile, and T-lymphocyte subsets: To evaluate immune-related hair loss;

• Thyroid function tests: To rule out endocrine disorders causing hair loss.

• Dermoscopy: To exclude other skin conditions and aid in diagnosing alopecia universalis.

What conditions can alopecia universalis be confused with?

Since the main symptom is hair loss, it may be mistaken for syphilitic alopecia, pseudopelade, or similar disorders. Doctors differentiate these through physical exams, reviewing hair loss history, and assessing past medical conditions.

TREATMENT

Which department should I visit for alopecia universalis?

Dermatology.

What are the treatment options for alopecia universalis?

Since the cause is unknown, there is currently no definitive treatment. Existing therapies involve a combination of approaches, mainly including:

• General treatment: Provide patient education and psychological therapy to help reduce stress and improve sleep. Additionally, wearing wigs may boost treatment confidence.

• Systemic treatment: High-dose corticosteroid pulse therapy is commonly used initially, followed by oral corticosteroids with gradual tapering. Side effects include central obesity, hypertension, diabetes, increased infection risk, and peptic ulcers. Azathioprine or methotrexate may be used for refractory cases, though reports are limited.

• Local treatment: Options include topical minoxidil (a vasodilator), corticosteroid applications, or 308 nm excimer laser therapy.

DIET & LIFESTYLE

What should patients with alopecia universalis pay attention to in their diet?

Since the cause of alopecia universalis is unknown, diet and exercise have no impact on it. However, maintaining a healthy lifestyle is beneficial for everyone's well-being.

What should people with alopecia universalis pay attention to in daily life?

Adjust your mindset, face life positively and optimistically, and adopt appropriate ways to relieve mental stress; ensure adequate sleep.

Does alopecia universalis affect fertility?

It does not affect fertility, but other complications should be considered based on specific conditions.

PREVENTION

Can alopecia universalis be prevented?

Since the cause of alopecia universalis is unknown, there is no clear prevention method. However, alopecia universalis often develops from alopecia areata, so early medical consultation to identify and address the cause of hair loss is recommended.

How to reduce the recurrence rate of alopecia universalis?

There is no effective way to prevent recurrence. Once alopecia universalis is detected, seek medical treatment promptly and follow the doctor's medication instructions.