|Person with alopecia universalis (Matt Richards)|
Alopecia universalis can occur at any age, and is currently believed to be an autoimmune disorder, in which a person's immune system attacks the hair follicles. Genetic factors may contribute to AU as approximately 20% of those affected have a family member with alopecia.
There is no standard treatment for alopecia universalis. Many treatments have been explored, including immunomodulatory agents such as imiquimod. Tofacitinib citrate may also have benefits. In June 2014, it was reported that a 25 year old man with almost no hair on his body grew a full head of hair, and eyebrows, eyelashes, facial, armpit and other hair, following 8 months of treatment.
Current Medical Treatments
- Contact Immunotherapy: Contact immunotherapy involves the use of contact allergens, such as diphencyprone (DPCP) and squaric acid dibutylester (SADBE), to induce an immune response that is thought to oppose the action of cells causing hair loss. A review that combined and analyzed the findings of 45 studies comprising 2227 patients showed any hair regrowth in 54.5% and complete hair regrowth in 24.9% of patients with AT and AU using contact immunotherapy. In addition to its helpful effects in treating AU, it can have side effects that can be very serious, like severe dermatitis.
- Corticosteroids: Topical and intralesional corticosteroids, such as clobetasol proprionate, have also shown to be an effective treatment for AT and AU patients. A controlled study comprising 28 patients found positive terminal hair growth in 8 of the patients (28.5%) using a 0.05% clobetasol propionate ointment. This is very similar to the results obtained from immunotherapy treatment trials. Additionally, studies suggest that intralesional applications are much more effective than topical applications of steroids. However, the main side effect is increased risk of cutaneous atrophy at the site of treatment; folliculitis is also an occasional complication.
Investigational and Future Medical Treatments
- JAK Inhibitors: Janus kinase (JAK) inhibitors, previously used in the treatment of cancer and other diseases, such as arthritis, have successfully shown to be effective in the initial trials of treatment for alopecia patients. There have been multiple cases of successful treatments, one of them being of a 22-year-old man with a history of AU and atopic dermatitis (AD). This man was treated with JAK inhibitor tofacitinib, and after 10 months he experienced hair regrowth on all of his affected body parts and subsequent improvement of his AD. Current research and findings suggest that systemic JAK inhibitors eliminate and prevent the development of AA, while topical JAK inhibitors promote hair regrowth and reverse the established disease. Many clinical trials are ongoing involving JAK inhibitors such as ruxolitinib and tofacitinib.
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