The Causes, Symptoms, and Treatments of Alopecia Totalis

Alopecia Totalis (AT) is a rare and more severe form of the autoimmune hair loss condition known as Alopecia Areata. Unlike its counterpart, which typically causes localized bald patches, AT leads to the complete loss of scalp hair. This sudden and total hair loss can be emotionally challenging and impact one’s self-esteem and quality of life. In this article, we will explore the causes, symptoms, and available treatment options for AT.

Profile of women showing showing alopecia totalis hair loss

What is Alopecia Totalis?

Alopecia totalis is a subtype of alopecia areata, a hair loss condition characterized by the complete loss of hair on the scalp. Unlike alopecia areata, which results in small bald patches, alopecia totalis leads to the entire scalp becoming completely bald. This form of hair loss is typically rapid in onset and is believed to have an autoimmune origin, where the body’s immune system mistakenly targets and attacks hair follicles. Managing alopecia totalis can be challenging, and while various treatments are available, responses can vary among individuals, making regrowth uncertain. The condition can have a profound emotional impact due to its sudden and dramatic change in appearance.

Causes of Alopecia Totalis

The exact cause of alopecia totalis is not fully understood, but it is believed to be an autoimmune disorder. In alopecia totalis, as in other forms of alopecia areata, the immune system mistakenly targets and attacks healthy hair follicles, leading to the complete loss of hair on the scalp. Several factors and mechanisms may contribute to the development of this autoimmune response:

  • Genetics: AT tends to run in families, suggesting a genetic predisposition. Individuals with a family history of the condition may be at a higher risk.
  • Autoimmune Response: The immune system, which normally defends the body against foreign invaders, such as viruses and bacteria, erroneously identifies hair follicles as threats and launches an immune response against them. This immune attack leads to hair loss.
  • Triggers: While the precise trigger for the autoimmune response is not always clear, various factors, including physical or emotional stress, illness or infections, and changes in hormone levels, have been proposed as potential triggers.
  • Environmental Factors: Some researchers believe that environmental factors, such as exposure to certain viruses or toxins, may play a role in triggering or exacerbating AT in susceptible individuals.
  • Other Autoimmune Conditions: There is a higher prevalence of other autoimmune disorders among individuals with alopecia areata, including conditions like thyroid disorders, vitiligo, or lupus, suggesting a possible connection between these conditions.

It’s important to note that alopecia totalis is not contagious, and it is not caused by poor hygiene or allergies. While the precise cause remains the subject of ongoing research, the autoimmune nature of the condition is a key factor in understanding why the immune system targets hair follicles, leading to complete hair loss on the scalp.

Symptoms of Alopecia Totalis

The primary symptom of alopecia totalis is the complete loss of hair on the scalp. Unlike other forms of alopecia areata, which may result in small, round bald patches, alopecia totalis leads to the absence of all scalp hair. Here are the key symptoms of alopecia totalis:

  • Total Hair Loss: The hallmark symptom is the total absence of hair on the scalp. This hair loss is typically rapid in onset, often occurring within a matter of weeks or months.
  • Smooth Scalp: The skin on the scalp in individuals with AT is usually smooth and appears healthy, without signs of redness, scaling, or irritation.
  • Eyebrow and Eyelash Loss: In some cases, AT can extend to involve the loss of eyebrows and eyelashes, resulting in complete hairlessness on the head and face.
  • Nail Changes: Although not always present, some individuals with AT may experience changes in their fingernails or toenails, such as pitting (small dents or depressions), white spots, or lines.
  • No Pain or Other Physical Symptoms: AT typically does not cause pain, itching, or other physical symptoms. It primarily affects the appearance of the scalp and hair.

The sudden and dramatic change in one’s appearance due to the complete loss of scalp hair can have a profound emotional and psychological impact on affected individuals. Coping with the psychosocial aspects of alopecia totalis, such as self-esteem and self-confidence, may be a significant aspect of managing the condition.

Treatment Options

Managing alopecia totalis can be challenging, as there is no one-size-fits-all solution, and the effectiveness of treatments can vary among individuals. Consequently, treatment options aim to stimulate hair regrowth and manage the autoimmune response responsible for hair loss. Here are some common approaches:

  • Topical Corticosteroids: These are anti-inflammatory creams or ointments applied directly to the scalp. They can help suppress the autoimmune response and promote hair regrowth. The choice of corticosteroid and its strength may vary depending on the severity of the condition.
  • Topical Immunotherapy: This treatment involves applying chemicals like diphencyprone (DPCP) or squaric acid dibutyl ester (SADBE) to the bald scalp. These chemicals induce a controlled allergic reaction, which can help modulate the immune response and encourage hair regrowth.
  • Topical Calcineurin Inhibitors: Medications like tacrolimus and pimecrolimus can be applied topically to the scalp as alternatives to corticosteroids. They work by suppressing the immune response in the affected area.
  • Oral Corticosteroids: In more severe cases or when other treatments are ineffective, oral corticosteroids may be prescribed. These medications have broader systemic effects and are typically used with caution due to potential side effects.
  • Janus Kinase (JAK) Inhibitors: Emerging treatments like oral JAK inhibitors (e.g., tofacitinib) have shown promise in clinical trials for alopecia areata, including AT. These medications target specific immune pathways and may be prescribed in certain cases.
  • Wigs and Hairpieces: For individuals with extensive hair loss, wigs, hairpieces, or hair extensions can provide a cosmetic solution to conceal hair loss.
  • Psychological Support: Coping with the emotional impact of AT is essential. Support groups and counseling can help individuals manage self-esteem, self-confidence, and emotional well-being.


Alopecia Totalis, a rare form of Alopecia Areata, causes the total loss of scalp hair, including eyebrows and eyelashes. While there is no definitive cure, various treatment options are available to manage the condition and stimulate hair regrowth. Consulting with a dermatologist or healthcare professional is crucial for developing a personalized treatment plan that suits the individual’s needs and helps them regain their self-esteem and sense of identity. Living with alopecia totalis may be a journey, but with the right support and approach, individuals can embrace their uniqueness and shine brightly in their own way.

Want to Learn More?

View the latest scientific paper on Totalis Alopecia from the National Library of Medicine.

Check Out popular Hair Loss Treatments