:Alopecia universalis
{{Infobox medical condition (new)
| name = Alopecia universalis
| image = Pierluigi Collina 2010.jpg
| synonyms =
| image_size = 222px
| caption = Former association football referee Pierluigi Collina with alopecia universalis.
| pronounce =
| field =
| symptoms = loss of all body hair
| complications =
| onset = any age
| duration =
| types =
| causes =
| risks =
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| differential =
| prevention =
| treatment =
| medication = Clobetasol propionate
| prognosis = normal life expectancy
| frequency =
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}}
__NOTOC__
Alopecia universalis (AU), also known as alopecia areata universalis, is a medical condition involving the loss of all body hair, including eyebrows, eyelashes, chest hair, armpit hair, and pubic hair. It is the most severe form of alopecia areata (AA).{{Cite web| url = https://rarediseases.info.nih.gov/gard/614/alopecia-universalis/resources/1| title = Alopecia universalis {{!}} Disease {{!}} Overview {{!}} Genetic and Rare Diseases Information Center (GARD) – an NCATS Program| website = rarediseases.info.nih.gov| access-date = 2016-03-01| archive-date = 2016-03-07| archive-url = https://web.archive.org/web/20160307081940/https://rarediseases.info.nih.gov/gard/614/alopecia-universalis/resources/1| url-status = dead}} People with the condition are usually healthy and have no other symptoms and a normal life expectancy.{{cite web |last1=Nancy Garrick |first1=Deputy Director |title=Alopecia Areata |url=https://www.niams.nih.gov/health-topics/alopecia-areata/advanced#tab-diagnosis |website=National Institute of Arthritis and Musculoskeletal and Skin Diseases |access-date=27 November 2021|date=4 April 2017}}
Causes
Alopecia universalis can occur at any age, and is currently believed to be an autoimmune disorder, 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.{{cite journal |last1=Robins |first1= Douglas N. |date=September 2007 |title=Alopecia Universalis: Hair Growth following Initiation of Simvastatin and Ezetimibe Therapy |url= https://jddonline.com/articles/dermatology/S1545961607P0946X |journal=Journal of Drugs in Dermatology |volume=6 |issue=9 |pages=946–7 |access-date=31 August 2020 |pmid= 17941369}}
Treatment
Many treatments have been explored, including immunomodulatory agents such as imiquimod.{{cite journal |vauthors =Letada PR, Sparling JD, Norwood C |title=Imiquimod in the treatment of alopecia universalis |journal=Cutis; Cutaneous Medicine for the Practitioner |volume=79 |issue=2 |pages=138–40 |year=2007 |pmid=17388216 }} 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.{{cite web|url=http://boston.cbslocal.com/2014/06/19/hairless-man-grows-full-head-of-hair-in-yale-arthritis-drug-trial/|title=Hairless Man Grows Full Head Of Hair In Yale Arthritis Drug Trial|publisher=CBS Boston|date=2014-06-19|access-date=2022-04-07}} 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).{{Cite web |last=Dillon |first=Kerry-Ann |title=A Comprehensive Literature Review of JAK Inhibitors in Treatment of Alopecia Areata |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC8242127/}}
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.{{Citation|last=Khan Mohammad Beigi|first=Pooya|title=Alopecia Totalis/Universalis|date=2018|work=Alopecia Areata: A Clinician's Guide|pages=13–15|editor-last=Khan Mohammad Beigi|editor-first=Pooya|publisher=Springer International Publishing|doi=10.1007/978-3-319-72134-7_3|isbn=9783319721347}}{{Cite journal|last1=Darwin|first1=Evan|last2=Hirt|first2=PenelopeA|last3=Fertig|first3=Raymond|last4=Doliner|first4=Brett|last5=Delcanto|first5=Gina|last6=Jimenez|first6=JoaquinJ|date=2018|title=Alopecia areata: Review of epidemiology, clinical features, pathogenesis, and new treatment options|journal=International Journal of Trichology|volume=10|issue=2|pages=51–60|doi=10.4103/ijt.ijt_99_17|pmid=29769777|pmc=5939003|issn=0974-7753 |doi-access=free }}{{Cite journal|last1=Pratt|first1=C. Herbert|last2=King|first2=Lloyd E.|last3=Messenger|first3=Andrew G.|last4=Christiano|first4=Angela M.|last5=Sundberg|first5=John P.|date=2017-03-16|title=Alopecia areata|journal=Nature Reviews Disease Primers|volume=3|pages=17011|doi=10.1038/nrdp.2017.11|issn=2056-676X|pmc=5573125|pmid=28300084}} 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.{{Cite journal|last1=Lee|first1=Won-Soo|last2=Lee|first2=Young Bin|last3=Kim|first3=Beom Jun|last4=Lee|first4=Solam|date=2018-10-01|title=Hair Regrowth Outcomes of Contact Immunotherapy for Patients With Alopecia Areata: A Systematic Review and Meta-analysis|journal=JAMA Dermatology|volume=154|issue=10|pages=1145–1151|doi=10.1001/jamadermatol.2018.2312|issn=2168-6068|pmc=6233743|pmid=30073292}} In addition to its helpful effects in treating AU, it can have side effects that can be very serious, such as severe dermatitis.{{Cite journal|last1=Strazzulla|first1=Lauren C.|last2=Wang|first2=Eddy Hsi Chun|last3=Avila|first3=Lorena|last4=Lo Sicco|first4=Kristen|last5=Brinster|first5=Nooshin|last6=Christiano|first6=Angela M.|last7=Shapiro|first7=Jerry|date=January 2018|title=Alopecia areata: An appraisal of new treatment approaches and overview of current therapies|journal=Journal of the American Academy of Dermatology|volume=78|issue=1|pages=15–24|doi=10.1016/j.jaad.2017.04.1142|issn=1097-6787|pmid=29241773}}
Topical and intralesional corticosteroids, 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.{{Cite journal|last1=Tosti|first1=Antonella|last2=Piraccini|first2=Bianca Maria|last3=Pazzaglia|first3=Massimiliano|last4=Vincenzi|first4=Colombina|date=July 2003|title=Clobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis|journal=Journal of the American Academy of Dermatology|volume=49|issue=1|pages=96–98|doi=10.1067/mjd.2003.423|pmid=12833016|issn=0190-9622}} 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 is also an occasional complication.
Janus kinase inhibitors, previously used in the treatment of cancer and other diseases, such as arthritis, have successfully shown to be effective in the initial trials of treatment for alopecia patients.{{Cite journal|last1=Clynes|first1=Raphael|last2=Christiano|first2=Angela M.|last3=Vaughan|first3=Roger|last4=Furniss|first4=Megan|last5=Ulerio|first5=Grace|last6=Clark|first6=Charlotte|last7=Cerise|first7=Jane E.|last8=Nguyen|first8=Nhan|last9=Jabbari|first9=Ali|date=2016-09-22|title=Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata|journal=JCI Insight|volume=1|issue=15|pages=e89790|doi=10.1172/jci.insight.89790|issn=0021-9738|pmc=5033756|pmid=27699253}} 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 (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.{{Cite journal|last1=Morris|first1=Gabriela M.|last2=Nahmias|first2=Zachary P.|last3=Kim|first3=Brian S.|date=2018-07-01|title=Simultaneous improvement of alopecia universalis and atopic dermatitis in a patient treated with a JAK inhibitor|journal=JAAD Case Reports|volume=4|issue=6|pages=515–517|doi=10.1016/j.jdcr.2017.12.016|pmid=30023415|issn=2352-5126|pmc=6047104}}{{Cite journal|last1=Navarini|first1=Alexander A.|last2=French|first2=Lars E.|last3=Trüeb|first3=Ralph M.|last4=Kamarachev|first4=Jivko|last5=Maul|first5=Julia-Tatjana|last6=Anzengruber|first6=Florian|date=2016|title=Transient Efficacy of Tofacitinib in Alopecia Areata Universalis|journal=Case Reports in Dermatology|language=en|volume=8|issue=1|pages=102–106|doi=10.1159/000445182|issn=1662-6567|pmc=4869306|pmid=27194979}} 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.{{Cite journal|last1=Clynes|first1=Raphael|last2=Christiano|first2=Angela M.|last3=Mackay-Wiggan|first3=Julian|last4=Petukhova|first4=Lynn|last5=Singh|first5=Pallavi|last6=Rothman|first6=Lisa|last7=DeStefano|first7=Gina M.|last8=Harel|first8=Sivan|last9=Jong|first9=Annemieke de|date=September 2014|title=Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition|journal=Nature Medicine|volume=20|issue=9|pages=1043–1049|doi=10.1038/nm.3645|issn=1546-170X|pmc=4362521|pmid=25129481}} Many clinical trials are ongoing involving JAK inhibitors such as ruxolitinib and tofacitinib.{{Cite journal|last1=Craiglow|first1=Brittany G.|last2=King|first2=Brett A.|date=December 2014|title=Killing Two Birds with One Stone: Oral Tofacitinib Reverses Alopecia Universalis in a Patient with Plaque Psoriasis|journal=Journal of Investigative Dermatology|volume=134|issue=12|pages=2988–2990|doi=10.1038/jid.2014.260|pmid=24940651|issn=0022-202X|doi-access=free}}
See also
References
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External links
{{Medical resources
| ICD11 = {{ICD11|ED70.2Y}}
| ICD10 = {{ICD10|L63.1}}
| ICD10CM =
| ICD9 = {{ICD9|704.09}}
| ICDO =
| OMIM = 104000
| OMIM_mult = {{OMIM|203655||none}} {{OMIM|610753||none}}
| MeshID = C537055
| DiseasesDB = 31298
| SNOMED CT = 86166000
| Curlie =
| MedlinePlus =
| eMedicineSubj =
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| PatientUK =
| NCI =
| GeneReviewsNBK =
| GeneReviewsName =
| NORD =
| GARDNum = 614
| GARDName = Alopecia universalis
| RP =
| AO =
| WO =
| OrthoInfo =
| Orphanet = 701
| Scholia = Q4734616
| OB =
}}
{{Disorders of skin appendages}}
{{Human hair}}