Alopecia Totalis

by Kathy Love

Alopecia disorders consists of a group of three main types namely, alopecia areata, alopecia universalis and alopecia totalis. As the name suggests alopecia totalis refers to a condition where a person suffers from total hair loss on the scalp.

According to some studies, alopecia totalis is a kind of auto-immune disorder which affects the hair follicles and prevents hair from growing. Other than the information that it is an auto-immune syndrome, studies on alopecia totalis haven’t determined the cause of the disorder.

In alopecia totalis, many a times the hair loss is sudden, but sometimes alopecia totalis originates from alopecia areata. This means that initially the patient starts loosing hair slowly and in patches, as in alopecia areata, but gradually this leads to alopecia totalis in which there is total hair loss.

Although people of any age and any gender can suffer from alopecia totalis, it is mostly seen to affect children, young-adults and people under the age of 40.

Other than total loss of hair leading to total baldness, there are no other obvious alopecia totalis symptoms. Normally the patient is absolutely healthy and capable of carrying out day-to-day duties. Alopecia totalis is usually neither contagious, nor is it painful or itchy like some other kinds of alopecia. In most cases total baldness occurs within 6 months from the time symptoms first appear.

Though any kind of hair loss is not a very harmful or life-threatening, it could cause much distress and frustration to people suffering from it. Therefore consultation with a dermatologist to seek advice on future course of treatment is required. There have been instances wherein the hair has been fully restored, but usually chances of the hair growing back completely are slim.

A number of treatment options have been suggested and used to treat alopecia totalis. For instance, some dermatologists suggest taking a daily dose of betamethasone (1 mg for children and 1.5 for adults). Provided action was taken right in the early stages of alopecia totalis, it was seen that this treatment proved beneficial (with some side-effects) in most patients.

Typically, alopecia totalis treatments put emphasis on immunomodulation therapies (therapies including drugs which affect the immune system). Normally, in most cases treatment includes:

  • Injecting steroids under the skin
  • Topical corticosteroids
  • Topical immunotherapy with the help of contact sensitizers or other means
  • Topical minoxidil
  • Photochemotherapy / PUVA
  • Use of wigs
  • Contact irritant therapy

Each treatment has its own limitation, for example, years of steroid therapy had its own negative side-effects and use of Rogaine (minoxidil) was seen to be inefficient in treating alopecia totalis. However treatment with topical application of corticosteroids was seen to be the most effective.

Even natural remedies like hypnosis and use of essential oils and even onion juice, have been explored to treat conditions like alopecia areata and alopecia totalis, however their effectiveness in every case is not proven.


Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2009: pp 932-934.;year=1996;volume=62;issue=2;spage=106;epage=109;aulast=Pasricha

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