Alopecia Universalis Treatment Options Everyday Health
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Left untreated, AU may increase your risk of depression and anxiety. This may be in part due to the highly unpredictable nature of this condition. Also, you may be at a higher risk for other autoimmune disorders, so your doctor will want to monitor you for underlying medical conditions.
What Are the Treatment Options for Alopecia Universalis
By Kristeen Cherney, PhDMedically Reviewed by Ross Radusky, MDReviewed: June 15, 2022Medically ReviewedTo treat alopecia universalis, your doctor may recommend topicals, oral meds, or injectables.Stocksy; iStock (2); CanvaAlopecia universalis (AU) is a subtype of alopecia areata, an autoimmune condition that causes your body’s immune system to attack hair follicles, leading to hair loss. AU is the most severe form of alopecia areata, and is known for complete scalp and body-wide hair loss.While alopecia areata itself is common, affecting up to 1 out of 500 to 1,000 individuals in the United States AU is much rarer, affecting about 1 percent of people with alopecia areata overall. While there’s currently no cure for AU, there are multiple treatment options you may consider discussing with a dermatologist. It’s even possible to experience hair regrowth, though only 10 percent of people with AU may achieve full recovery. “Previously the prognosis for people with AU was poor; however, there is now so much reason to be hopeful, as there are now finally effective treatments on the horizon,” says Brittany Craiglow, MD, of Dermatology Physicians of Connecticut and an associate adjunct professor of dermatology at Yale School of Medicine in New Haven. What are the treatments for AU, and what do they involve? Read on to learn more about what AU options may be available for hair regrowth so you can discuss these further with your dermatologist.Why Treating AU Is Challenging
Technically, there aren’t any AU-specific treatments approved by the FDA. But several existing treatments have been found to work for people experiencing hair loss from AU. Many of these treatments are used in people with other autoimmune diseases. Not every treatment method works for everyone, and it may require some trial and error before you find an effective therapy. A combination of treatments may also be most effective for hair regrowth, and you may see results gradually. Below are the medications, therapies, and other treatment measures to consider for AU.Editor' s Picks
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In considering AU treatment, your dermatologist may first consider oral immunosuppressants. These types of medications work by stopping your immune system from overreacting and causing cellular inflammation and damage.In the case of AU, immunosuppressants may help by preventing your immune system from attacking healthy hair follicles.Oral corticosteroids (“steroids”), such as prednisone, are some of the oral immunosuppressants used in the treatment of AU. As with other autoimmune diseases, oral steroids may be considered as first-line treatments early in the course of AU to help stop an overactive immune system in its tracks. Sometimes steroids, such as methylprednisolone, may be combined with cyclosporine, another type of immunosuppressive medication. Janus kinase (JAK) inhibitors, such as ruxolitinib and tofacitinib, may be prescribed off-label in the treatment of AU. While not formally FDA-approved to treat skin conditions, JAK inhibitors are typically prescribed for immune-mediated conditions, such as rheumatoid arthritis and thrombocytopenia, but your doctor may consider these oral medications to help stop the immune system from attacking hair follicles in AU. According to Dr. Craiglow, JAK inhibitors are among some of the more “promising” AU treatment options.Topical Therapies
Several topical therapies may be considered in treating AU, and they may be preferable to oral medications as long-term solutions because of side effect concerns. Your dermatologist may recommend one or a combination of the following topical treatments:Topical corticosteroids These may come in the form of creams, ointments, or foams, and are rubbed into your skin daily. Contact immunotherapy In this experimental treatment, a dermatologist uses sensitizing agents such as diphenylcyclopropenone (DPCP) to reduce the immune system’s attacks on hair follicles. This may help promote hair regrowth in AU, but it tends to work best in individuals who have experienced less than 50 percent hair loss. Also, it may take up to three months to see results, and it’s possible to experience severe skin rashes and swollen lymph nodes from this treatment option. Minoxidil Better known by its brand name, Rogaine, minoxidil is sometimes recommended for alopecia, and it may be useful for AU when combined with other treatments as directed. While typically used on the scalp, minoxidil may also be recommended to help with eyebrow hair regrowth. It can take up to 12 weeks to see hair regrowth with minoxidil. Bimatoprost This prescription eye drop treatment is approved for glaucoma as well as eyelash growth. Your dermatologist may prescribe these eye drops to aid eyelash regrowth with AU.Corticosteroid Injections
While conventional AU treatments primarily consist of oral and topical medications, certain types of injections may also be used to reduce inflammation and promote hair regrowth.The first option consists of injectable corticosteroids, which may be applied to the scalp, eyebrows, and beard areas. The goal is to increase the rate of hair regrowth, but the effects may be temporary, requiring the need for repeat injections. If you do see results with these injections, your dermatologist may also recommend that you use topical minoxidil to maintain your results.Biologic Injectables
While primarily used in the treatment of rheumatic diseases, tumor necrosis factor (TNF) inhibitors, which belong to a drug class known as biologic therapies, are an area of continued interest in the treatment of AU. One study outlined the success of a type of TNF inhibitor called adalimumab (Humira), which is an immunosuppressive drug used in the treatment of rheumatoid arthritis, Crohn’s disease, and other inflammatory conditions. As discussed in a case study of one woman in her thirties, TNF inhibitors like adalimumab helped decrease high TNF levels that are often found in AU, and are thought to contribute to loss of hair growth. That said, more research is needed to determine whether adalimumab and other TNF inhibitors may lead to hair regrowth for all people with AU. Possible side effects of these injections may include skin reactions, infections, and, rarely, neurological complications.Light Therapy
Phototherapy, or light therapy, is a dermatological treatment that’s used to treat a variety of skin diseases. For example, eczema may be treated with phototherapy when other treatment methods fail. This treatment works with the use of ultraviolet (UV) light to target a large area of skin to reduce inflammation. Photodynamic therapy (PDT), a type of phototherapy that uses photosensitizing drugs, may be particularly helpful for treating alopecia. PDT is also used to treat certain forms of skin cancer, psoriasis, and acne. While research indicates photodynamic therapy may be a helpful treatment for AU, other experts believe there isn’t enough clinical evidence to support phototherapy alone for the treatment of alopecia areata. Craiglow also doesn’t recommend phototherapy as a viable treatment option for AU.Natural Remedies Diet and Lifestyle Changes
While some natural remedies are currently being studied for alopecia areata more generally, there currently isn’t enough evidence to support the use of any herbs or alternative practices as reliable hair regrowth options for AU. “There are no natural remedies known to impact the course of alopecia areata,” says Craiglow.Also, while there’s no single diet or lifestyle change that can reverse AU, a healthy diet and reduced stress may help improve your quality of life. “Presently there is not any good data to support any dietary or lifestyle changes for this disease,” Craiglow says. “That being said, it is never a bad idea to eat a balanced diet, get regular exercise, and try to minimize stress.”Additionally, it’s important to protect bare skin from the sun. You may consider wearing headscarves or hats, as well as sunglasses.Why Hair Transplants Don t Work for AU
In considering widespread hair loss reversal, you may have thought about hair transplants. But Craiglow says this treatment measure does not work for AU. “First, hair transplants utilize a person’s own hair, so you need to have hair to transplant,” she explains. “But more importantly, in alopecia areata hair loss occurs as the result of inflammation around the hair follicles, which will also impact any transplanted hair and cause it to fall out as well.”Outlook for People Undergoing Treatment for AU
While AU is more severe than other types of alopecia areata, up to 10 percent of people with this condition may experience full hair regrowth and recovery. You may experience continuous cycles of hair loss and regrowth, and some of the hair that is lost may not grow back.Left untreated, AU may increase your risk of depression and anxiety. This may be in part due to the highly unpredictable nature of this condition. Also, you may be at a higher risk for other autoimmune disorders, so your doctor will want to monitor you for underlying medical conditions.