Alopecia Universalis (AU) – What Is It?

Alopecia universalis (AU) is a condition that is characterized by the complete loss of hair on the scalp and body. It is a more advanced form of alopecia areata, a condition that is characterized by patchy hair loss.(1). While the exact cause is still unknown, it has been classified as an autoimmune disease. This is where an individuals immune system mistakenly attacks their body or in this case the individuals hair follicles (2).

Furthermore, it is believed that the interaction between environmental and genetic factors plays a role in the onset of AU (3). While there is currently no cure for AU, there are many medical trials being undertaken to treat it (4).

Alopecia Universalis – Quick Facts

• Alopecia Universalis does not permanently damage the hair follicles (4)
• There currently is no cure for Alopecia Universalis (4)
• Hair can regrow, even after years since the onset of the condition (5)

Symptoms

Characterized by complete loss of hair on both the scalp and body (4). The majority of individuals with AU do not have any other signs and/or symptoms that is attributed to the onset of AU (5). However, there have been isolated cases where some individuals experience an itching or burning sensation on areas where hair loss is present (4).

The vast majority of alopecia universalis case stems from alopecia areata, which usually begins as patchy hair loss (3)(5). Hair loss is sudden with bald spots appearing in just a couple days, with complete loss of hair occurring over an average of 90 days or less (4).

Causes

As mentioned previously, alopecia universalis is believed to be a more advanced form of another condition called alopecia areata (AA) (4). While the exact cause is unknown researchers believe that certain factors may increase the risk for this form of hair loss.

AU is listed as an autoimmune disease (2). An autoimmune disease with respect to AU is when the body's own immune system mistakes hair follicles as foreign entities (2)(4). Due to this, the immune system attacks hair follicles in order to protect itself (2)(4). This act results in total hair loss.

Genetics

It is theorised that AU is hereditary, in other words, it is thought that alopecia universalis runs in families (6). So, if someone in your family develops this condition there could be a genetic connection. Contrary to most inherited conditions, in order for AU to materialize both parents must contribute specific genes to pass AA to their children which is a precursor to AU (6).

This type of inherited condition is referred to as a polygenic disease, meaning "multiple genes" (7). Due to the fact that it requires specific genes from both parents, most people with either AA or AU will not end up passing on the condition to their children (7).

Can Stress Lead To Alopecia Universalis?

It has not yet been definitively proved that stress causes alopecia universalis. However, it is possible that extreme stress in addition to certain genetics (see above) and immune system problems could trigger both AA and AU (2)(8). It must be stated that no medical / research studies have proven this theory.

There are however cases where stress results in hair loss (9). This condition is called telogen effluvium, which the result of physical/emotional stress (9). Anxiety, surgery, child birth, emotionally stressful events medications are among just a few examples (9).

This form of hair loss takes place over the course of several months after the stressful event (9). The areas affected areas return to their normal state within a few months (9). Note, this condition is not related to alopecia universalis.

How Is It Diagnosed?

The symptoms of alopecia universalis are distinct (4). Doctors or dermatologists can usually diagnose AU after inspecting the patterned signs of hair loss (4). Alopecia universalis leaves very smooth skin (no scars), with extensive and mostly total hair loss (4)(5).

In some cases, medical professionals may order a biopsy in order to confirm the nature of the condition and to check for any other skin conditions (10). For an acute diagnosis medical professionals may ask for blood tests in order to look for the presence of any other health conditions (10).

Can It Be Treated? What Are Your Options

While The National Institutes of Health (NIH) have definitively said that there is no cure for alopecia universalis, there are treatment options available. Treatment options depend on several factors such as an individuals age, medical history and degree of hair loss (10).

In the absence of reliable options for treatments, these are some medications that may work:

Diephenylcyclopropenone (DPCP) – DPCP is an experimental sensitising agent which is employed by some dermatology centres to treat various skin conditions. Some conditions include but are not limited to, alopecia areata and alopecia universalis (11).

When applied topically (on the skin) DPCP results in allergic contact dermatitis (inflammation) (11). With respect to AA/AU, it is believed to work by redirecting the body's autoimmune attacks from the hair follicles (2)(11).

Steroids – Steroids work by calming down the body's immune response and inflammation (12).

Ultra-Violet Light Therapy – Your doctor may also recommend UVLT in order to promote blood circulation (13). This would serve to stimulate growth of hair follicles (13).

Living With Alopecia Universalis

Due to the nature of the condition, some people suffer mental health and emotional issues as they lose their hair (4). While some people find comfort by wearing a hair piece/wig, whereas others do not (4).

What ever the case may be, it is extremely important for individuals with AU to protect their scalp. This can be done by using protective head coverings, hats, lotions etc.

Scalp Micropigmentation, An Emerging Treatment Option

Alopecia Vs Scalp Micropigmentation

In the video below we have a young man from the UK by the name of Jake. He and his mother came to our studio located in New York because after doing their research, they believed that Gerow Hair Ink was the only provider that could provide the results they were looking for. Have a look at his video below.

WHAT IS SCALP MICROPIGMENTATION?

Scalp Micropigmentation (SMP) is an advanced hair loss treatment option. It involves the creation of follicular hair unit sized impressions in the scalp that perfectly mimic an individuals own hair follicles. Great expertise is required in order to correctly position these pigment filled impressions so they do not blotch and cause a 'blow out' or quickly fade.

Scalp micropigmentation is the fastest growing solution in the history of hair loss prevention – that is a fact. From thinning hair and male pattern baldness to scarring and the various forms of alopecia, scalp micropigmentation is the only solution that provides results.

In just the last decade, the industry has grown from zero to over 1500 technicians worldwide. With more than 150,000 men and women now thought to have had the procedure, the industry is experiencing an unprecedented rate of growth.

Takeaway

While there is yet no cure for alopecia universalis, there are many treatment options that are available that treat AU in different ways (5).

Alopecia universalis itself does not pose any risks to an individuals physical health however, their emotional health may be affected (4)(5). It is recommended that individuals with this condition should seek out support groups, clinical trials for new/emerging treatments (SMP) and/or join organizations for those with hair loss.

Gerow Hair Ink

At GEROW HAIR INK we’ve always said that we love what we do and that seeing our clients happy was our only satisfaction. When we started on this journey, scalp micropigmentation was a grass roots movement.

We were committed to make hair loss a thing of the past and provide both Men & Women with a better option that doesn’t involve invasive and in most cases damaging surgery.

Resources:

1. Olsen E.A., Hordinsky M.K., Price V.H. Alopecia areata investigational assessment guidelines–Part II. National Alopecia Areata Foundation. J Am Acad Dermatol. 2004;51:440–447.
2. Andersen Y.M.F., Egeberg A., Gislason G.H., Skov L., Thyssen J.P. Autoimmune diseases in adults with atopic dermatitis. J Am Acad Dermatol. 2017;76(2):274–280.e1.
3. Villasante Fricke AC, Miteva M. Epidemiology and burden of alopecia areata: A systematic review. Clin Cosmet Investig Dermatol. 2015;8:397–403.
4. Jang YH, Hong NS, Moon SY, Eun DH, Lee WK, Chi SG, et al. Long-term prognosis of alopecia totalis and alopecia universalis: A Longitudinal study with more than 10 years of follow-up: Better than reported. Dermatology. 2017;233:250–6
5. Penzi L.R., Yasuda M., Manatis-Lornell A., Hagigeorges D., Senna M.M. Hair regrowth in a patient with long-standing alopecia totalis and atopic dermatitis treated with dupilumab. JAMA Dermatol. 2018;154(11):1358–1360.
6. Ahmad W, Faiyaz Ul Haque M, Brancolini V, Tsou HC, Ul Haque S, Lam H, et al. Alopecia universalis associated with a mutation in the human hairless gene. Science. 1998;279:720–4
7. Sundberg JP, Silva KA, Li R, et al. Adult-onset alopecia areata is a complex polygenic trait in the C3H/HeJ mouse model. J Invest Dermatol. 2004;123:294–7
8. Peters EM, Liotiri S, Bodó E, et al. Probing the effects of stress mediators on the human hair follicle: substance P holds central position. Am J Pathol. 2007;171:1872–86.
9. Rebora A, Guarrera M, Baldari M, Vecchio F. Distinguishing androgenetic alopecia from chronic telogen effluvium when associated in the same patient: a simple noninvasive method. Arch Dermatol. 2005;141(10):1243–1245.
10. Mounsey AL, Reed SW. Diagnosing and treating hair loss. Am Fam Physician. 2009;80:356–362.
11. Galadari I, Rubaie S, Alkaabi J, Galadari H. Diphenylcyclopropenone (diphencyprone, DPCP) in the treatment of chronic severe alopecia areata (AA) Eur Ann Allergy Clin Immunol. 2003;35:397–401.
12. Das S, Ghorami RC, Chatterjee T, Banerjee G. Comparative assessment of topical steroids, topical tretenoin (0.05%) and dithranol paste in alopecia areata. Indian J Dermatol. 2010;55(2):148–149.
13. Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers Surg Med. 2014;46:144–151. doi:10.1002/lsm.22170

Images:

1. Figure 1: https://alliance4hair.com/alopecia-totalis/
2. Figure 2: Free resource – commercial use, no attribution necessary
3. Figure 3: Free resource – commercial use, no attribution necessary
4. Video 1: Gerow Hair Ink -https://www.youtube.com/watch?v=MljNLGQdgJ0&t=67s