The Causes, Symptoms, and Treatments of Alopecia Universalis

Alopecia Universalis (AU) is an exceedingly rare and extreme form of hair loss, encompassing the total absence of hair on the entire body, including the scalp, eyebrows, eyelashes, and body hair. This condition can be emotionally distressing and profoundly impact an individual’s self-esteem and sense of identity. In this article, we will explore the causes, symptoms, and available insights into the challenging realm of alopecia universalis.

Man showing no eyebrows as a results of alopecia universalis hair loss

What is Alopecia Universalis?

Alopecia universalis represents an advanced and rare variant of alopecia areata, a hair loss condition. In this form, individuals encounter the most extensive hair loss. Not only does the scalp loses all its hair, but the entire body is devoid of it. This condition is rooted in an autoimmune basis, where the immune system erroneously directs its attack towards hair follicles. This effectively impedes any hair growth. The uniqueness of alopecia universalis lies in its impact on both the scalp and the overall appearance of the body. Although various treatments are available for its management, responses to treatment can be unpredictable, and regrowth cannot be guaranteed. Coping with the psychosocial aspects of complete hair loss often emerges as a significant facet of managing alopecia universalis.

Causes of Alopecia Universalis

Alopecia universalis is characterized by complete hair loss on the scalp and body. It is believed to have an autoimmune basis. While the exact cause is not fully understood, the prevailing theory is that it is an autoimmune disorder.

Here’s how the autoimmune mechanism is thought to work:

  • Immune System Dysfunction: In individuals with AU, it is believed that the immune system mistakenly identifies hair follicles as foreign invaders and launches an immune response against them.
  • Autoimmune Attack: The immune response triggers inflammation around the hair follicles, leading to their destruction and preventing the normal growth of hair.
  • Complete Hair Loss: This autoimmune attack is particularly aggressive in AU, resulting in the complete loss of hair not only on the scalp but also from the entire body, including the eyebrows, eyelashes, and body hair.

While genetics may play a role in predisposing individuals to autoimmune disorders like alopecia universalis, specific triggers for the immune response are not always clear. Factors such as stress, infections, and hormonal changes may contribute to the development or exacerbation in susceptible individuals.

Research into the precise causes of alopecia universalis is ongoing, but the autoimmune nature of the disorder is a key feature that distinguishes it from other forms of hair loss.

Symptoms of Alopecia Universalis

Alopecia universalis stands out with a profound and distinct symptom: complete hair loss of the scalp and body. Let’s explore the primary symptoms of alopecia universalis:

  • Complete Hair Loss: The most prominent symptom is the total absence of hair on the scalp, face (including eyebrows and eyelashes), and body. This results in a completely bald appearance.
  • Smooth Skin: The affected skin on the scalp and other areas typically appears smooth and devoid of hair. There are usually no signs of redness, scaling, or irritation associated with the hair loss.
  • Absence of Body Hair: Unlike other forms of alopecia, which may target specific body areas, AU leads to the loss of all body hair This includes hair on the arms, legs, chest, and pubic area.
  • Nail Changes: Some individuals with AU may also experience changes in their fingernails or toenails, such as pitting (small dents or depressions), white spots, or lines. These nail changes resemble those seen in other forms of alopecia areata.
  • No Pain or Other Physical Symptoms: It’s important to note that AU typically doesn’t cause itching, pain, or other physical symptoms. Its primary impact is on appearance due to the complete absence of hair.

The sudden and dramatic transformation in one’s physical appearance can have a significant emotional and psychological impact on individuals. Coping with the psychosocial aspects of hair loss, including self-esteem and self-confidence, plays a significant role in managing the condition.

Treatment Options

Alopecia universalis, marked by the complete loss of hair on both the scalp and the entire body, presents treatment challenges. The effectiveness of treatments can vary widely among individuals, and regrowth is not guaranteed. Here are some treatment options that may be considered:

  • Topical Corticosteroids: Anti-inflammatory creams or ointments, when applied directly to the affected areas, may help suppress the autoimmune response and promote hair regrowth. However, their effectiveness in extensive forms like AU is often limited.
  • Topical Immunotherapy: Chemicals like diphencyprone (DPCP) or squaric acid dibutyl ester (SADBE) applied to the scalp can provoke an allergic reaction, potentially modulating the immune response and stimulating hair regrowth. This treatment can be more effective in some cases of AU.
  • Topical Calcineurin Inhibitors: Medications like tacrolimus and pimecrolimus can be applied topically to suppress the immune response in the affected areas, particularly for individuals who do not respond well to corticosteroids.
  • Oral Corticosteroids: In more severe cases or when other treatments prove ineffective, oral corticosteroids may be prescribed. However, their broader systemic effects and potential side effects warrant cautious consideration.
  • Janus Kinase (JAK) Inhibitors: Emerging treatments like oral JAK inhibitors (e.g., tofacitinib) have shown promise in clinical trials for alopecia areata, including AU. 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 and improve self-esteem.
  • Psychological Support: Given the emotional impact of complete hair loss, support groups and counseling can be invaluable for individuals with AU to address self-esteem, self-confidence, and emotional well-being.


Alopecia universalis, an exceedingly rare and challenging form of alopecia areata, results in the total loss of body hair. While there is no definitive cure, various treatment options are available to manage the condition and potentially stimulate hair regrowth. Seeking consultation with a dermatologist or healthcare professional is essential to develop a personalized treatment plan that addresses the individual’s unique needs, helping them regain self-esteem and embrace their unique beauty. Though living with alopecia universalis may be a journey, the right support and approach can empower individuals to shine brightly, even without hair.

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