What is Alopecia Universalis? All You Need to Know About Symptoms, Treatment, Causes, and Diagnosis

Key takeaways:

• What is alopecia universalis? Alopecia universalis is a rare subtype of alopecia areata. It is an immune-mediated inflammatory medical condition involving the complete or near-complete loss of hair from the body, including the scalp, face, and extremities.¹
  
• Why does it happen? It can affect people of any age or gender. The reason why it happens is not fully understood, but currently it is believed to be a combination of genetic susceptibility and a potential trigger such as stress, illness, or infection. 
  
• Is there a chance my hair will grow back? Because the hair follicles are not destroyed in alopecia universalis, it’s always possible that some hair might regrow. However, this is unlikely in patients with alopecia universalis when you have a large area of hair loss, or if the hair loss started from a young age. 
  
• Can alopecia universalis be treated? Currently, there is no cure. Treatments can be used to reduce the immune system response and encourage hair regrowth. Some options include corticosteroids, which dampen the immune system response, and other medications which work by stopping immune signals that cause inflammation. Your response to these medications can vary, and it is best to discuss the benefits and risks with your GP or dermatologist.
  
• Can I get a hair transplant with alopecia universalis, and what if I cannot? We can’t perform a hair transplant on people who have alopecia universalis, as the same process that affected your original hair can also affect transplanted follicles. Instead, management involves medications and practical steps like using wigs, hairpieces, eyebrow or eyelash cosmetics, and sun protection. While not physically harmful in itself, its impact can be deeply personal. Losing scalp, facial, and body hair can affect confidence and day-to-day wellbeing, which is why an important aspect of care is sensitive medical advice and emotional support.²

What is alopecia universalis?

Alopecia universalis involves the complete loss of hair from the body. It is a type of hair loss where the immune system impacts the hair follicles. It is the most extensive subtype of alopecia areata, as it involves the greatest degree of hair loss. It is considered an immune-mediated non-scarring type of hair loss.

This is another way of saying that the immune system, which usually protects our body, has mistakenly identified our own hair follicles as a target. The hair follicles that are targeted are not destroyed.¹ While there is a chance the hair might grow back, it is increasingly unlikely the larger the area of hair that is affected initially and the younger the age at onset.³

What are the differences between alopecia universalis, alopecia areata, and alopecia totalis

Alopecia universalis is a subtype of alopecia areata which involves the greatest amount of hair loss.

These terms describe increasing extent of hair loss, from patchy hair loss in alopecia areata to total scalp hair loss in alopecia totalis to loss of most or all hair-bearing areas in alopecia universalis.

What are the Symptoms of alopecia universalis?

Hair loss can appear gradually or suddenly. In some cases, it develops from patchy areas mainly on the scalp which end up merging over months before eventually affecting the rest of the body hair. Other times, it can appear suddenly, and within a matter of days or weeks, large amounts of hair can be shed, resulting in total or near-total body hair loss, which can be alarming.

There may be an itching, burning or tingling sensation in the affected area before or after the hair loss. There may be itchy and dry eyes caused by the loss of eyelashes. You may notice small dents on your nails called pitting, or that they become brittle and weak.²

What are the Causes and risk factors for alopecia universalis?

Exactly what causes alopecia universalis remains unknown. What we do know is that there is inflammation of the hair follicles, typically believed to be autoimmune. The hair follicles are normally protected from recognition and attack by the body’s immune system. However, in alopecia universalis, it appears this protection is lost, allowing the hair follicles to be targeted and for hair to fall out. In the case of alopecia universalis, all the body is affected, leaving a person completely or nearly completely without hair.

There appears to be a genetic link, as 1 in 5 people affected have a family history of immune-related hair loss conditions. There also appears to be a link to other autoimmune conditions such as diabetes, vitiligo and thyroid disease.¹

Another trigger can be environmental, such as emotional stress. Equally, physical stress on the body, such as illness or infection, has been a reported trigger. These are not simple direct causes, and in many people the causative spark is not known.

How is Alopecia Universalis Diagnosed?

The diagnosis is made largely based on the presenting features and a physical examination by a doctor. Most patients will not need any special tests to confirm the diagnosis, as it is a quite unique and remarkable presentation. The doctor will most likely ask questions to try and rule out any conditions that may have similar signs. However, in alopecia universalis, the main sign is complete hair loss, and the patient otherwise feels physically well.

The doctor may also carry out some of the following tests to rule out other conditions:

• Skin biopsy (small sample of skin for further inspection) -to rule out fungal infection or other autoimmune causes
  
• Blood tests – to check for thyroid and other autoimmune conditions
  
• Trichoscopy (which involves using a microscope-like device to look at the skin and hair follicles in closer detail)

Testing is a simple and accurate way to help confirm the diagnosis of alopecia universalis and begin implementing strategies that will improve the well-being of the patient, allay any anxieties or fears caused by the hair loss, and improve their quality of life.

What are the Treatment options for alopecia universalis?

Treatment options are usually limited, and no known cures exist for this condition. Whether or not the hair might regrow is difficult to predict and purely depends on the response of each person’s own body.

In alopecia universalis, the hair loss is extensive at diagnosis. This is a poor indicator for hair regrowth, which means it is unlikely to be fully reversed successfully. For example, in a study carried out, more than 9 in 10 of those who presented with complete scalp hair loss still had extensive absence of hair when followed up.³

While there is no definitive treatment, the focus of medical treatments is on changing the immune system’s inflammatory response in the hope that it will allow the hair to regrow without being disrupted. These treatments may include the following:

• Contact sensitisation treatment such as diphencyprone (DPCP). This is when a substance that causes an inflammatory reaction is applied to the scalp in a weak form. The resulting inflammation is then regularly reapplied and maintained. In some cases, the irritation caused by the inflammation stimulates hair regrowth.^2,5
  
• Corticosteroids (topical steroids, steroid injections, prednisone, and clobetasol). These steroids, applied topically(on the skin surface) or perhaps taken in tablet form or injected, might be able to suppress the immune response and allow the hair to grow back.^2,5
  
• JAK inhibitors (Ritlecitinib). A newer class of tablets that impact the immune system. They dampen down the immune response and help reduce inflammation and hopefully also the symptoms of alopecia universalis in those aged 12 and over.⁴

Treatment response varies from person to person. Some patients may see regrowth, while others may have little or no response. Each also carries their own risks of side effects. It is best to discuss the benefits, limitations, and risks of treatment options with a GP or dermatologist before starting treatment.

Can a hair transplant treat alopecia universalis?

A hair transplant is unfortunately not recommended to treat alopecia universalis because it is an immune-mediated phenomenon. This means that the transplanted hair follicles would also be subject to the same process that has impacted existing hair follicles.

At the Treatment Rooms London, we specialise in surgical management of hair loss. As alopecia universalis has no known surgical solutions, we cannot recommend any of our treatments for this condition. We advise that you get in touch with your GP or healthcare provider with any concerns you may have about your symptoms.

“Alopecia universalis is different from patterned hair loss because it is an autoimmune condition that can affect hair follicles throughout the entire body. This same immune process may also affect transplanted follicles, which is why hair transplantation is not considered an appropriate treatment for this condition.

As surgeons, it is important that we are honest when surgery is not the right option and explain this compassionately to the patient. In these cases, we collaborate with dermatologists so that patients can receive the appropriate medical treatment and support for their condition.”

Dr Roshan Vara, Director and Hair Transplant Surgeon, The Treatment Rooms London 

Living with Alopecia Universalis

Understandably, the loss of a person’s hair can be emotionally and psychologically damaging. People’s appearance and perception of themselves can be drastically altered by hair loss.

It is not uncommon for people to experience mental or emotional health issues as a result. The use of a wig or a hairpiece is a common method used by people to feel better about their appearance. Others may decide that a wig is not for them.

There is no right or wrong option; it is all up to individual preference. For eyebrow and eyelash loss, some people may choose options such as false eyelashes, eyebrow pencils, eyebrow stickers, microblading, or cosmetic tattooing to recreate these features in a style they like.

Given the additional lack of protection from UV rays caused by the hair loss, it is vitally important to continue to protect the scalp and other sensitive areas, especially through the application of sun cream or the use of other sun-protective coverings such as hats, wigs, and scarves, etc.

Many people find it helpful to connect with others who are sharing a similar experience. To be able to meet others in a similar space can boost psychological wellbeing while also minimising feelings of being alone with this condition.

There are also dedicated organisations for people with hair loss, such as Alopecia UK, which can provide support, community and education for patients. 

With the right guidance and support, people with alopecia universalis can optimally manage their condition and continue living their lives with full well-being and confidence.

““Experiencing any degree of hair loss can already have a significant psychological impact, so it is easy to understand how losing all of your hair can affect confidence and self-esteem even more. These feelings are entirely valid and understandable and should never be dismissed as vanity.

Alongside medical treatment, emotional and psychological support can be just as important. Patients should also know that they do not have to go through this alone. They should be encouraged to reach out to support groups and organisations such as Alopecia UK, as well as connect with others who have experienced similar hair loss, which can all make a meaningful difference.”

Dr Roshan Vara, Director and Hair Transplant Surgeon, The Treatment Rooms London 

References.

1. Harries MJ, Ahmed A, Ascott A, Bhatti K, Earley J, Farrant P, et al. British Association of Dermatologists living guideline for managing people with alopecia areata 2025. Br J Dermatol. 2026;194(2):e56-e73. doi:10.1093/bjd/ljaf452.

2. British Association of Dermatologists. Alopecia areata [Internet]. London: British Association of Dermatologists; 2024 [cited 2026 Jul 8]. Available from: https://bad.org.uk/pils/alopecia-areata 

3. Tosti   A, Bellavista   S, Iorizzo   M.  Alopecia areata: a long term follow-up study of 191 patients. J Am Acad Dermatol  2006; 55:438–41. 

4. National Institute for Health and Care Excellence. Ritlecitinib for treating severe alopecia areata in people 12 years and over. Technology appraisal guidance TA958. London: NICE; 2024. 

5. Mateos-Haro M, Novoa-Candia M, Sánchez Vanegas G, Correa-Pérez A, Gaetano Gil A, Fernández-García S, Ortega-Quijano D, Urueña Rodriguez MG, Saceda-Corralo D, Bennouna-Dalero T, Giraldo L, Tomlinson J, Vaño-Galván S, Zamora J. Treatments for alopecia areata: a network meta-analysis. Cochrane Database of Systematic Reviews 2023, Issue 10. Art. No.: CD013719. DOI: 10.1002/14651858.CD013719.pub2. 

Alopecia Universalis is a rare autoimmune disorder that causes total body and scalp hair loss. It can be very distressing to live with and can affect people of any age. In this article, we’ll go through what you need to know about Alopecia Universalis from the symptoms and diagnosis to treatment options and tips on managing this condition daily.

What is Alopecia Universalis?

Alopecia Universalis is a rare autoimmune alopecia, causing total hairloss affecting both the scalp and body. It occurs when your immune system mistakenly attacks healthy hair follicles and prevents them from growing new hair. It can cause sudden and complete loss of all scalp and body hair over the entire surface area, including eyelashes, eyebrows, facial hair and pubic/underarm hair (1). Alopecia Universalis may occur at any age but is much more common in adults aged 20 to 40. While it has no known cure, various treatments exist to help regrow some stray hairs if administered early enough while the condition is still in its active phase.

Alopecia Universalis signs and symptoms

Common symptoms include:

• Loss of hair on the body
• Shortening of hair and loss of hair in the eyebrow and eyelashes
• Loss of hair on the scalp

One of the primary symptoms of Alopecia Universalis is total hair loss from all areas of the body, including facial hair. This type of alopecia can be identified by examining the scalp and skin for signs that suggest complete baldness. Some itching or irritation in the affected area may also accompany the condition.

Other symptoms of of the condition may include a shortening or loss of eyelashes and eyebrows. In addition, the sufferer may notice thinning hair in other areas such as their chest, pubic area, beard or legs. The affected person may also experience flaky skin or scales on the scalp.

It is important to note that Alopecia Universalis is not restricted to the head and face. You can also experience hair loss in other areas of the body, such as the arms and legs. While some people may experience temporary hair regrowth, this usually does not last long and eventually leads to complete baldness(2).

Alongside facial and body hair loss, suffererrs of Alopecia Universalis also lose hair on their scalp. The condition can therefore be identified by examining the scalp and skin for signs of complete baldness.

If you are demonstrating any of these symptoms or signs it is important to consult a medical professional as soon as possible. Early diagnosis and treatment can be key to managing this condition and preventing further hair loss.

Causes of Alopecia Universalis

Alopecia Universalis can be precipitated by a number of events with patients often having an underlying genetic predisposition to the condition.

• Genetic Predisposition: Studies have shown that those who develop Alopecia Universalis are more likely to have a family history of the disorder, indicating that genetics plays a role in developing this condition.

• Physical or Emotional Trauma: Physical trauma or emotional stress can trigger the onset of Alopecia Universalis in some individuals. Severe physical injuries, such as burns or other serious wounds, can also trigger the immune system and result in Alopecia Universalis. Similarly, extreme emotional stress like a family member death can cause an autoimmune reaction leading to hair loss.

• Medical Conditions: Certain medical conditions may be linked to the condition. These include certain types of cancer, lupus, and thyroid diseases.

Diagnosis of Alopecia Universalis

To diagnose alopecia Universalis, a variety of tests can be used. These range from physical examinations to laboratory tests that look for signs of inflammation or infection in the scalp and hair follicles ruling out other rare conditions that can cause hair loss. The following are commonly used tests:

• Physical examination – This involves examining the patient’s scalp and skin, assessing hair loss patterns, and ruling out other possible causes.

• Trichoscopy – This test uses a special device to look for signs of inflammation or infection in the scalp and hair follicles for a more accurate diagnosis.

• Blood tests – These tests measure levels of certain hormones, such as testosterone and thyroid-stimulating hormone (TSH). Abnormal levels can indicate another possible cause of hair loss

• Skin biopsy – Sometimes, a skin sample is taken from the scalp for microscopic examination. This can help rule out other causes of hair loss, such as fungal infections or another type of autoimmune related hair loss condition

Using these tests together makes it possible to accurately diagnose Alopecia Universalis and provide the most effective treatment for each patient. Early diagnosis and treatment can help reduce the impact of Alopecia Universalis on quality of life.

Management of Alopecia Universalis

Treatment for alopecia Universalis may include:

• Topical Steroids: topical steroids are the most common treatment for Alopecia Universalis. They can be applied directly to the scalp and are usually prescribed in a strength correlating to the severity of the condition. They are usually applied twice daily and may take several months to show results.

• Oral Steroids: Oral steroids are generally prescribed for more severe cases and they can be more effective than topical treatments. These medications reduce inflammation in the scalp, which helps promote hair growth but risk wider side effects on the body.

• Immunotherapy: Immunotherapy involves exposing the scalp to a mild irritant, such as diiphencyprone (DPCP), which causes inflammation and encourages the body to produce antibodies against the irritant. As a result, this can help to stimulate hair regrowth in some cases.

These are some of the treatment options available for Alopecia Universalis. However, it is important to note that these treatments can fail to provide any benefit. It is best to discuss all options with a doctor or healthcare provider to determine the best course of action for the patient. In many cases, a combination of medications and treatments may be necessary to achieve optimal results (1).

Can you perform a hair transplant for Alopecia Universalis?

Unfortunately a hair transplant will not work for patients suffering from Alopecia Universalis. The body’s immune system is likely to affect transplanted hair follicles meaning they won’t grow wherever they are transplanted.

Complications of Alopecia Universalis

Alopecia Universalis is a rare autoimmune disorder resulting in hair loss from the scalp and body. While this condition does not typically cause physical symptoms, there are numerous complications associated with alopecia Universalis that can impact both physical and mental health.

The first complication to consider is the emotional impact. People with condition may experience distress, low self-esteem, and anxiety due to the physical changes associated with their condition. They may also be subject to bullying or harassment from others unfamiliar with the disorder.

A second complication is a physical discomfort resulting from the lack of hair on the scalp. Without hair to protect it, the skin may become irritated or sunburned more easily than normal, even with sunscreen or hats. Additionally, people with the condition may experience a higher susceptibility to heat exhaustion and dehydration due to the lack of protection against UV rays (1).

The complications associated with Alopecia Universalis can significantly impact both physical and mental health. It is important for individuals living with the condition to address any emotional distress they may be experiencing and to seek medical attention as soon as possible if they develop signs of infection or another skin condition. Additionally, they should protect their scalp from sun damage and find clothing and headgear that is comfortable to wear over the affected areas. With enough care and support, individuals can manage their condition and live happy, healthy lives.

Conclusion

Alopecia Universalis is a disease that causes hair loss on the scalp and often on other body parts. It can affect both men and women but is more common in women. There is no cure for the condition, but treatments can help slow down hair loss or promote new growth.

References

1: Burroway, B., Griggs, J., & Tosti, A. (2020). Alopecia totalis and universalis long‐term outcomes: a review. Journal of the European Academy of Dermatology and Venereology, 34(4), 709–715. https://doi.org/10.1111/jdv.15994

2: Kassira, S., Korta, D. Z., Chapman, L. W., & Dann, F. (2017). Review of treatment for alopecia totalis and alopecia universalis. International Journal of Dermatology, 56(8), 801–810. https://doi.org/10.1111/ijd.13612