Alopecia Universalis (AU) Lecture Notes

Definition and Overview

• Alopecia Universalis (AU), also known as alopecia areata universalis, is a severe medical condition.
• Characterized by the complete loss of hair on the body, including:
  • Eyebrows
  • Eyelashes
  • Chest hair
  • Armpit hair
  • Pubic hair
• It is the most severe form of alopecia areata (AA).
• People with AU are generally healthy with a normal life expectancy.

Causes and Age of Onset

• AU can occur at any age.
• Believed to be an autoimmune disorder where the immune system attacks hair follicles.
• Genetic factors may play a role, with about 20% of affected individuals having a family history of alopecia.

Treatments Explored

• Immunomodulatory agents like imiquimod.
• Tofacitinib citrate has shown potential benefits:
  • A case study showed a 25-year-old man regrowing body hair after eight months of treatment.
• No single therapy is universally accepted due to cost and side effects.
• Contact immunotherapy:
  • Uses contact allergens (e.g., diphencyprone, squaric acid dibutylester) to stimulate an immune response.
  • Meta-analysis of 45 studies showed 54.5% had some hair regrowth; 24.9% had complete regrowth.
  • Side effects include severe dermatitis.
• Corticosteroids:
  • Topical and intralesional (e.g., clobetasol propionate) have shown effectiveness.
  • A controlled study with 28 patients resulted in 28.5% experiencing hair regrowth.
  • Intralesional applications more effective than topical applications.
  • Main side effect: cutaneous atrophy; occasional folliculitis.

Janus Kinase Inhibitors

• Used previously for cancer and other diseases.
• Initial trials show effectiveness for alopecia patients.
• A case involved a 22-year-old man with AU and atopic dermatitis, treated with tofacitinib, who showed significant improvement.
• Systemic JAK inhibitors appear to eliminate and prevent AA, while topical JAK inhibitors promote hair regrowth.
• Ongoing clinical trials with JAK inhibitors like ruxolitinib and tofacitinib.

Summary

• Various treatments have been explored, but challenges remain due to side effects, costs, and the impermanent nature of results once treatment stops.
• Research continues into more effective and sustainable therapies for AU.