Alopecia Totalis

About Dr Jaspreet Sarna
Dr. Sarna is an MD (Skin & VD) and Gold Medalist from Baroda Medical College. She has a decade long experience in treating hair loss and working on hair regrowth. She believes stress management is the key to good health.
Alopecia totalis is a hair loss condition in which you lose all of your hair including your brows, lashes and boy hair. What triggers it and what are the treatment options? Read on to find out more.
Alopecia Totalis

Believed to be an autoimmune condition, alopecia totalis is characterized by a total loss of hair on the scalp. The exact reasons for the condition are a matter of discussion among experts. Here, we try to look at the condition, its symptoms, and its treatment.

Alopecia totalis causes hair loss and is categorized as a skin condition. It is different from alopecia areata which is localized and is characterized by the hair loss on the scalp in patches whereas alopecia totalis causes complete hair loss on the scalp resulting in total baldness. Alopecia totalis is also different from alopecia universalis as in the latter there is a complete hair loss all over the body and is not limited to the scalp.

In some cases of alopecia totalis, there may be an effect on the eyebrow and eyelashes too. It is generally accepted that alopecia totalis is an autoimmune condition. Here, the immune system of the body attacks the healthy cells of the hair follicles. This causes inflammation of the hair follicles. The condition usually develops in one of the two forms. Either there is a sudden loss of all scalp hair or there is an onset of alopecia areata in the form of round patches of hair loss, which further develops into alopecia totalis causing complete hair loss on the scalp.

What Are the Causes of Alopecia Totalis

The exact causes for alopecia totalis are still unknown. Most researchers and experts however settle on one conclusion – that this is an autoimmune condition. 

  • Your immune system is the natural defense system of the body against attack by pathogens, saving you from illness. Sometimes, the immune system mistakes healthy cells and tissues as a threat and starts attacking them. This is known as an autoimmune condition. In alopecia totalis, the immune system mistakes the hair follicles as a threat and starts attacking them. The immune system releases a chemical known as cytokine which attacks the hair follicles causing inflammation. This inflammation at the hair follicle site leads to hair loss.

  • Experts believe that the presence of specific genes makes some people more vulnerable as compared to others. A majority of people suffering from alopecia totalis had family members who had the same condition. Thus, the genetic factors are at play in causing alopecia totalis. If you have these specific genes you are more likely to develop this condition. This would be generally triggered by coming in contact with factors such as allergies, viruses, or other toxins that activate the immune system of the body.
  • Sometimes, alopecia totalis is linked to stress. However, there is very little evidence to corroborate this correlation.

Who is at Risk of Alopecia Totalis

The reasons for alopecia totalis are not yet clear but that it is an autoimmune condition is agreed upon by a majority of experts. Though it is unclear why people develop autoimmune conditions, certain risk factors may place you at a higher risk of developing this condition.

  • Due to the possible genetic nature of the condition, some people are more at risk compared to others. If there is a history of the condition in your family, you are at the risk of developing alopecia totalis. If you are diagnosed with this condition, there is likely someone in your family with the same diagnosis.
  • Alopecia totalis is more common in people with autoimmune conditions. If you are having diabetes or hyperthyroidism, you are at a higher risk.
  • Though the condition can develop at any age, alopecia totalis is more commonly observed in people aging less than 40 years.
  • It has been observed that around 5% of children who have alopecia areata may develop alopecia totalis in the future.
  • Though the correlation between stress and alopecia totalis is not strong, chronic stress does weaken your immune system and can be considered a risk factor.

How to Diagnose Alopecia Totalis

You should know the alopecia totalis symptoms so that if you observe these, you can visit a clinic for diagnosis. Though the symptoms vary across different individuals, the most common ones include – 

  • Excessive hair loss on the scalp. Alopecia areata totalis usually begins with hair thinning that furthers into bald patches. In some cases, the hair loss can be sudden and rapid.
  • Few people experience itching and tingling sensations in the scalp. Soreness and bumps on the scalp may accompany.
  • Few people have brittle nails when this condition affects them.

Alopecia is a skin disorder and hence it is best to consult a dermatologist in case you are observing these symptoms. 

  • Your complete medical history will be studied first.
  • The doctor will conduct a physical examination of the head and understand the hair loss pattern. Further testing may follow to confirm the diagnosis.

        *A scalp biopsy, which involves taking a skin sample from the scalp and testing it in a laboratory

        *A blood test, to ascertain if an autoimmune disease is the cause of the condition

  • This condition is very common and expert doctors may simply need a visual examination.

Products to Treat Alopecia Totalis

Alopecia totalis treatment cannot be guaranteed although few therapies and medications have shown some results. Homeopathic treatment for alopecia totalis has also shown some results. The course that alopecia totalis can take in an individual cannot be predicted. Alopecia totalis hair regrowth can be achieved through treatments but the condition may relapse while you’re in the middle of progress. If not diagnosed and controlled in time, alopecia totalis may progress into alopecia universalis.  Alopecia universalis cure is equally unpromising. You are recommended to consult your doctor on priority if you observe symptoms. After diagnosis and confirmation, you might be suggested one or more of the below medications and therapies - 

  • Corticosteroids
  • These suppress the immune system and can be taken as injections or pills. However, these have long-term side effects.

  • Minoxidil
  • Can be used by all age groups. Hair may start to grow in three months if this medication is used along with other therapies.

  • Diphencyprone
  • This treatment stimulates an allergic reaction, increasing the white blood cell count. This stimulates the hair follicles promoting hair growth.

  • Ultraviolet light therapy
  • This increases blood circulation and stimulates hair follicles.

    Alopecia totalis can be permanent or temporary. It is recommended that you start the treatment as early as possible. This way it is easier to contain the disorder. This is a very common condition but total hair loss may result in psychological stress. We recommend that you keep the counseling on and do not let this common disorder result in the onset of stress that might bring with it many other problems.

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