Introduction

Definition of Alopecia Universalis

Alopecia universalis (AU) is a condition that causes complete hair loss of the scalp and the body. This is different to alopecia areata, which causes patches of hair loss on the scalp. The exact cause of AU is still not understood, but it is thought to be an autoimmune condition that causes your immune system to mistakenly attack your hair follicles.^1,2

Importance of understanding

It is important to understand what it means to have AU because it can impact an individual's self-esteem, and affect them emotionally due to the psychological effects of hair loss. There are also limited treatment options that are proven to be effective, so it is very important to be compassionate and understanding.^1,2

Medical treatments^3,4,5

There are a few different classes and options when it comes to medications for AU. They are included below:

Corticosteroids 

• Types: There are various types and formulations, including topical (applied to skin), oral (taken by mouth), and intravenous(IV) options
• Mechanism: They suppress the immune system to prevent it from targeting the hair follicles
• Effectiveness: It is limited, and in some cases, hair regrowth is only temporary
• Side effects: skin thinning, weight gain, high blood pressure

Immunosuppressant medications

• Examples: Methotrexate, cyclosporin
• Mechanism: suppress the immune system to prevent it from attacking the hair follicle 
• Effectiveness: successful in certain cases
• Side effects: Increases your risk of infections, liver damage and kidney damage

JAK inhibitors

• Examples: Tofacitinib, ruxolitinib 
• Mechanism: Inhibits Janus kinase pathways, which are cellular communication systems involved in the immune response
• Effectiveness: showed promising results in clinical trials 
• Side effects: Increased risk of serious infections and blood clots 

Biological medications 

• Drugs: Dupilumab, etanercept
• Mechanism: Targets specific parts of the immune system 
• Effectiveness: there are still ongoing studies on these medications
• Side effects: allergic reactions and risk of infections

Topical and alternative treatments^5,6

Topical immunotherapy 

• Chemicals: Diphenylcyclopropenone (DPCP), squaric acid dibutyl ester (SADBE)
• Mechanism: When applied to the skin, they produce a mild allergic reaction to divert your immune response away from your hair follicles.
• Effectiveness: Some hair regrowth in 30-50% of patients 
• Side effects: skin irritation, discomfort

Minoxidil

• Mechanism: Dilates blood vessels to promote blood flow to the hair follicles and hair regrowth, as well as the formation of new hair follicles 
• Effectiveness: more effective in other types of hair loss and limited for AU
• Side effects: itching and irritation in the scalp

Natural and holistic approaches

• Options: essential oils, acupuncture and dietary supplements 
• Effectiveness: Not supported by clinical evidence
• Risks: can have allergic reactions or other adverse effects

Emerging and experimental treatments^3,4,5

Stem cell therapy 

• Mechanism: Uses stem cells to regenerate hair follicles 
• Status: still in the early stages of research with limited clinical trials 
• Challenges: It can be expensive, and there is limited access to stem cells 

Platelet-rich plasma (PRP) therapy

• Mechanism: involves injecting concentrated platelets to promote hair regrowth 
• Effectiveness: has shown mixed results, and there is limited data for AU
• Side effects: Mild pain and swelling

Non-medical options for managing Alopecia Universalis³

Wigs and hairpieces

• Types: synthetic or human hair
• Advantages: immediate cosmetic solution and customisable 
• Disadvantages: can be costly and may require maintenance

Scalp micropigmentation

• Technique: tattooing to simulate hair follicles 
• Benefits: long-lasting and low maintenance
• Risks: risk of infections and the colour can fade

Summary

AU is a condition that is still not fully understood, which causes a complete loss of hair of the body and scalp. Even though the exact cause is not fully understood, there is treatment available, ranging from medications to non-medical options, such as wigs. Your doctor and the healthcare team will do their best to help you through the journey of regaining your confidence and ability to feel like yourself.