Alopecia areata universalis - Causes - Treatment

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What is alopecia areata universalis?
Universalis is an extreme type of alopecia areata (AA).

A. areata universalis causes complete loss of hair over the entire scalp, face and body. A.areata universalis is considered to be an autoimmune disorder. It may occur at any age in both the genders. In about 60% of cases, the first initiation of hair loss may occur before 20 years. There is no specific cause for alopecia areata universalis disorder and there is no standard treatment. Complete regrowth is possible without any treatment. Some persons may have repeated cycles of hair loss and regrowth. Approximately 1 in 100,000 of the population is affected by alopecia areata universalis.

As in many autoimmune diseases, some unknown factors trigger and cause the immune system to mistakenly attack hair follicles and arrest the growth of hair. Fortunately, the hair follicle stem cells remain alive and with appropriate immune signal the normal hair growth may resume. It may take a few months to a few years to outgrow the AA. universalis disorder and resume the natural regrowth. In some unfortunate persons regrowth may never occur. AA. universalis is often psychologically devastating with severe social and emotional impact.

Causes of alopecia areata universalis

Alopecia areata universalis is not contagious and is considered to be an autoimmune disorder.

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It is caused by the body's immune system considering its own hair follicles as foreign bodies and attacking them. However the stem cells contributing to the development of hair follicles are left unharmed.

As in most of the autoimmune diseases, hereditary predisposition is a major contributing cause of AA. universalis. Angela M. Christiano et al of Columbia University Medical Center uncovered eight genes responsible for the onset of the hair loss disorder. Gene ULBP3 and two other genes are expressed in hair follicle attracting cells marked by a killer cell receptor, known as NKG2D. Other five genes are connected with immune response.

The differences in causes for individuals to lose hair only as circumscribed patches on the head or to lose totally on the head and body are not clearly known.

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Hormones, extreme stress, allergies, environmental factors, presence of autoimmune diseases, viruses, chemicals, toxins, infection and medicines might cause, contribute or trigger AA. universalis in genetically predisposed individuals.

Alopecia areata universalis may also cause extrafollicular involvement in nails as pitting, koilonychias and onycholysis. AA.universalis is also known to cause ocular changes such as lens opacities, decrease in visual acuity and cataracts.

Treatment options for alopecia areata universalis

Many AA. universalis treatment options are available. The results are not consistent and show varying levels of success among individuals.

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Extensive hair loss makes the treatment prolonged and difficult. As earlier said the stem cells of hair follicles are unaffected by the immune system attack. This leaves a window open for the regrowth of the hair at a later date when the particular autoimmunity wanes or triggering factors withdraw. In some AA. Universalis patients, the regrowth may start naturally without any treatment. Camouflaging hair loss with a wig is the best solution in persisting AA. universalis. We may consider a few of the treatment options available.

Cortisone injections, creams and pills:

Topical corticosteroids and intralesional corticosteroid injections show good results in patients with patchy hair loss. However AA.universalis responds poorly to intralesional corticosteroid injections and topical corticosteroids. Systemic corticosteroid pills have been found to be effective in the treatment of AA.universalis.

Topical Minoxidil:

Minoxidil stimulates proliferation and differentiation of the keratinocytes and is helpful in persons with patchy hair loss. However in patients with AA. universalis the regrowth is poor.

Dithranol:

Dithranol has immunosuppressant and anti-inflammatory properties. In some patients with AA. universalis, dithranol has been observed to cause positive response. Its use requires further studies and standardization.

Topical immunotherapy:

Topical immunotherapy have been found to be effective in the treatment of alopecia areata universalis. In this procedure allergic contact dermatitis is induced by applying a potent contact allergen. The contact allergen is applied periodically to cause sensitization. The sensitization of the scalp brings about immunomodulatory actions which inhibit the autoimmune reaction against the hair follicle. 50-60% of alopecia areata universalis patients undergoing topical immunotherapy treatment achieve a worthwhile response.

Immunosuppressive agents:

Immunosuppressive agents azathioprine, cyclosporine and sulfasalazine have been tried in the treatment of AA. universalis with positive results. However these medicines cause side effects such as gastrointestinal distress and liver toxicity.

Tofacitinib citrate

Brittany G Craiglow et al in their trial on a person with both plaque psoriasis and alopecia areata universalis, administered tofacitinib citrate, a rheumatoid arthritis drug. The patient grew a full head of hair, facial hair and body hair. The medication was mildly effective on psoriasis. Further studies are being carried out on this novel treatment for alopecia areata universalis.

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References:
1.Deepak SH, Shwetha S. Scalp roller therapy in resistant alopecia areata. J Cutan Aesthet Surg 2014;7:61-2
2.Brittany G Craiglow, Brett A King. Killing Two Birds with One Stone: Oral Tofacitinib Reverses Alopecia Universalis in a Patient with Plaque Psoriasis. Journal of Investigative Dermatology | doi:10.1038/jid.2014.260.
3.Imran Majid, Abid Keen. Management of alopecia areata: an update. BJMP 2012;5(3):a530.
Current topic in natural skin care: Causes of alopecia areata universalis and its treatment.