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What is Alopecia Totalis?

By Emma Lloyd
Updated May 21, 2024
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Alopecia totalis is a type of alopecia that causes total loss of head hair, including all facial hair, eyebrows and eyelashes. This total head baldness often occurs within six months of the onset of the condition. The underlying cause of alopecia totalis and other types of alopecia is thought to be an autoimmune disorder. Many people with this condition find that their hair loss is exacerbated by stress, but alopecia is not limited to people with high-stress lifestyles.

Alopecia totalis is a more severe version of alopecia areata, in which hair is lost in patches from the scalp and other areas of the body. A third type of alopecia, called alopecia universalis, leads to the loss of all body hair, including the scalp, face, trunk, limbs and genital area. All of these types of alopecia are recurrent conditions that do not cause any harm to a person’s physical health but can cause considerable psychological and emotional stress.

A considerable amount of evidence points to an autoimmune disorder as the cause of alopecia. Immune cells and antibodies that are sensitized to destroy hair follicles have been found in people with alopecia, indicating that their immune systems have somehow become primed to attack these cells. In one study, 90 percent of people with alopecia were found to have antibodies that were able to attack certain structures in hair follicles.

Scientific evidence also suggests that genetics plays a role in the development of alopecia totalis. One study found that up to 20 percent of people with alopecia have a family history of the condition, whereas less than two percent of people who do not have alopecia have this family history. This and other evidence indicates that certain genes can increase the likelihood that someone will develop alopecia. In the global population, an individual has approximately a 1.7 percent chance that he or she will develop some form of alopecia; the most common type is alopecia areata.

Alopecia totalis treatment involves the use of topical medications or injections. For people with less than 50 percent scalp hair loss, the most commonly used of these are corticosteroid injections or topical creams. Approximately 60 percent of people who receive regular scalp injections of corticosteroids will experience hair growth within four to six weeks of the first injection.

When more than 50 percent of scalp hair has been lost, treatment is more likely to consist of topical immunotherapy medications. Chemicals such as squaric acid dibutylester are used to induce a mild form of contact dermatitis at the site of hair loss. As a result, the autoimmune response that causes hair loss is inhibited, allowing hair to regrow. Hair growth generally begins between 12 and 24 weeks after the first treatment.

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