What Is Alopecia Areata Universalis?

Alopecia areata is an autoimmune condition characterized by discrete round patches of hair loss on the scalp, face, and, sometimes, on other areas of the body.

People with alopecia areata may develop other autoimmune diseases. They may experience nail changes, such as pitting or stippling (rows of tiny dents) on their fingernails. Both fingers and toenails could be affected.

Alopecia areata can begin at any age, but most people develop it during childhood or their teenage years.

1. Alopecia areata:
   • There is a development of one or more round or oval patches on the scalp or other places of hair growth.
   • May or may not convert into alopecia totalis (hair loss across the entire scalp) or universalis (hair loss across the entire body).
2. Persistent patchy alopecia areata: Characterized by patchy scalp hair loss, which may continue over an extended period without developing into extensive alopecia areata.
3. Alopecia totalis: Results in hair loss across the entire scalp.
4. Alopecia universalis: An advanced form of alopecia areata, which results in hair loss across the entire scalp and face (including eyebrows and eyelashes) and the rest of the body (including pubic hair).
5. Diffuse alopecia areata: Results in rapid, widespread, sudden, and unexpected thinning of the hair over the scalp.
6. Ophiasis alopecia: Has a unique pattern of hair loss, which may include the sides and lower back of the scalp in the shape of a band.

Although the exact cause of alopecia universalis is unknown, researchers speculate it to be an autoimmune condition (the immune system mistakenly attacks the hair follicles).

Certain variations in human leukocyte antigen (HLA) genes contribute to the inappropriate immune response targeting hair follicles that leads to alopecia areata.

The following people have a greater risk of developing alopecia areata:

• A parent or a close relative with the condition: If a parent or close blood relative has (or had) alopecia areata, the child has a greater risk of developing this disease.
• People with asthma, hay fever, atopic dermatitis, thyroid disease, vitiligo, or Down syndrome: Research reports that people who have any of these diseases are more likely to get alopecia areata.
• Got treated with a cancer drug called nivolumab: Hair loss typically begins a few months after initiating the treatment.
• Environmental and psychological triggers: Trauma, viral infection, or stress may trigger the autoimmune reaction of alopecia areata.

The symptoms of alopecia areata may differ among people and can range from mild to severe. These may include:

• Isolated patchy and focal hair loss without any signs of rash, redness, or scarring
• One or more round or oval (coin-sized) patches on the scalp or other areas of the body
• Absence of eyebrows
• Absence of eyelashes
• Ophiasis alopecia (a band or strip of bald skin on the scalp)
• Alopecia universalis (a complete loss of hair on the entire body)
• Brittle and cracked nails

Alopecia areata is diagnosed based on the typical clinical features, but additional tests could be required, such as:

• Trichoscopy: Examination of the hair follicle, hair shaft, and scalp using a dermatoscope.
• Hair pull test: Grasping 40 to 60 closely grouped hair and applying gentle traction to look if hairs are pulled out easily.
• Skin biopsy: To confirm the diagnosis through histopathology.

When someone has a few bald patches, hair may regrow within 12 months without any treatment. In some cases, unpredictable cycles of hair loss followed by regrowth of hairs can last for years.

Though alopecia areata cannot be cured, medical treatments may help, such as:

• For children younger than 10 years
  • Prescription-strength corticosteroids: To be applied one or two times a day on the bald spots.
  • Rogaine (minoxidil): Helps maintain hair regrowth.
• For 10 years and older
  • Corticosteroid injections
  • Topical medications
    • Minoxidil solution
    • Dithranol (anthralin) cream or ointment
  • Immunosuppressants
  • Janus kinase inhibitors
  • Psoralen (photochemotherapy along with ultraviolet radiation therapy)

Complications of alopecia areata

• Changes in appearance
• Decreased quality of life
• Low self-esteem
• Anxiety
• Depression
• Emotional or psychological issues
• A high risk of other autoimmune conditions, such as thyroid disease, vitiligo, psoriasis, diabetes mellitus, and atopy