__NOTOC__ Alopecia universalis (AU), also known as alopecia areata universalis, is a

medical condition A disease is a particular abnormal condition that adversely affects the structure or function (biology), function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical condi ...

involving the loss of all body hair, including

eyebrows An eyebrow is an area of short hairs above each eye that follows the shape of the lower margin of the brow ridges of some mammals. In humans, eyebrows serve two main functions: first, communication through facial expression, and second, preve ...

, eyelashes,

chest hair Chest hair is hair that grows on the chest in the region between the neck and the abdomen. Chest hair develops during and after puberty along with other types of androgenic hair. Development and growth Although vellus hair is already present ...

armpit hair Underarm hair, also known as axillary hair or armpit hair, is the hair in the underarm area (''axilla''). Development Underarm or axillary hair goes through four stages of development, as staged by the Wolfsdorf Axillary Hair Scale, driven by ...

, and

pubic hair Pubic hair (or pubes , ) is terminal hair, terminal body hair that is found in the sex organ, genital area and pubic region of adolescent and adult humans. The hair is located on and around the sex organs, and sometimes at the top of the inside ...

. It is the most severe form of

alopecia areata Alopecia areata (AA), also known as spot baldness, is a condition in which hair loss, hair is lost from some or all areas of the body. It often results in a few Baldness, bald spots on the scalp, each about the size of a coin. Psychological st ...

(AA). People with the condition are usually healthy and have no other symptoms and a normal life expectancy.

Causes

Alopecia universalis can occur at any age, and is currently believed to be an

autoimmune disorder An autoimmune disease is a condition that results from an anomalous response of the adaptive immune system, wherein it mistakenly targets and attacks healthy, functioning parts of the body as if they were foreign organisms. It is estimated tha ...

, in which a person's immune system attacks the hair follicles. Genetic factors may contribute to AU, as about 20% of those affected have a family member with alopecia.

Treatment

Many treatments have been explored, including immunomodulatory agents such as

imiquimod Imiquimod, sold under the brand name Aldara among others, is a medication that acts as an immune response modifier that is used to treat genital warts, superficial basal cell carcinoma, and actinic keratosis. Scientists at 3M's pharmaceutica ...

. Tofacitinib citrate may also have benefits. In June 2014, a 25-year-old man with almost no hair on his body was reported to have grown a full head of hair, as well as eyebrows, eyelashes, and facial, armpit, and other hair, following eight months of treatment. However, there is no single accepted therapy, for which has systematically proven to be effective and for which the benefits would outweigh the costs (e.g., Tofacitinib is expensive and has side effects; treatment effects disappear with discontinuation of treatment). Contact immunotherapy involves the use of contact allergens, such as diphencyprone and squaric acid dibutylester, to induce an immune response that is thought to oppose the action of cells causing hair loss. 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. In addition to its helpful effects in treating AU, it can have side effects that can be very serious, such as severe

dermatitis Dermatitis is a term used for different types of skin inflammation, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened ...

. Topical and intralesional

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

s, such as clobetasol propionate, have also shown to be an effective treatment for AT and AU patients. A controlled study comprising 28 patients found positive terminal hair growth in eight of the patients (28.5%) using a 0.05% clobetasol propionate ointment. 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;

folliculitis Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head. A ...

is also an occasional complication.

Janus kinase inhibitor A Janus kinase inhibitor, also known as JAK inhibitor or jakinib, is a type of immune modulating medication, which inhibits the activity of one or more of the Janus kinase family of enzymes ( JAK1, JAK2, JAK3, TYK2), thereby interfering with ...

s, previously used in the treatment of cancer and other diseases, such as

arthritis Arthritis is a general medical term used to describe a disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, Joint effusion, swelling, and decreased range of motion of ...

, have successfully shown to be effective in the initial trials of treatment for alopecia patients. Multiple cases of treatments have been successful, one of them being of a 22-year-old man with a history of AU and

atopic dermatitis Atopic dermatitis (AD), also known as atopic eczema, is a long-term type of inflammation of the skin. Atopic dermatitis is also often called simply eczema but the same term is also used to refer to dermatitis, the larger group of skin conditi ...

(AD). This man was treated with JAK inhibitor tofacitinib, and after ten months, he experienced hair regrowth on all of his affected body parts and subsequent improvement of his AD. 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. Many clinical trials are ongoing involving JAK inhibitors such as

ruxolitinib Ruxolitinib (sold under the brand names Jakafi and Jakavi among others, and as Opzelura in cream form) is a medication used for the treatment of intermediate or high-risk myelofibrosis, a type of myeloproliferative neoplasm that affects the b ...

and tofacitinib.

References

External links

{{Human hair Autoimmune diseases Conditions of the skin appendages Hair diseases Human hair Rare diseases

Causes

Treatment

See also

References

External links