ALOPECIA TOTALIS and UNIVERSALIS
By Gary M. White, MD
In alopecia totalis (AT), the patient loses all scalp hair. In alopecia universalis (AU), the patient loses all scalp and body hair. Both of these variants of alopecia areata (AA) are relatively rare.
- It is estimated that approximately 5% of cases of AA will progress to AT or AU.
- The median time to development of AU or AT after onset of hair loss is 1 year (and 91% by 4 years) [JEADV 2017;550].
- Approximately 20% of AU or AT patients have thyroid disease (so measure TSH) [JEADV 2017;550].
If total scalp and body hair is lost within the first month of life, consider atrichia with papular lesions.
See alopecia areata for treatment options. Tofacitinib shows promise [JEADV 2016;30;1373]. Patients may wear a wig.
This adult male with alopecia universalis lost all his nose hair leading to increased nasal drainage.
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