Alopecia totalis and universalis long‐term outcomes: a review

Abstract

Alopecia totalis (AT) and universalis (AU) represent the most severe subtypes of alopecia areata with more dramatic features and worse prognosis. The goal of this review is to identify all studies with long‐term prognostic data on patients with AT and AU and provide a long‐term outcome estimate. The PubMed database was queried to identify all articles discussing the long‐term prognosis of AT and AU. A total of nine articles discussing long‐term recovery rates of AT and AU were identified. The articles described 689 (162 = AT, 245 = AU, 282 = not specified) total patients. Six of the nine studies identified complete recovery as a potential end point in a total of 375 (39 = AT, 75 = AU, 261 = not specified) patients. According to these studies 8.5% (32/375) of AT and AU patients achieved complete recovery. A larger proportion of patients will obtain at least transient recovery periods of partial or total hair regrowth. The poor long‐term outcomes of AT and AU may cause patients to lose hope with treatment. Response to treatment is often unpredictable, and physicians should be aware of the prognosis and its effects in order to properly counsel patients.

Validation of the Alopecia Areata Patient Priority Outcomes (AAPPO) Questionnaire in Adults and Adolescents with Alopecia Areata

“…Eligible patients were adults (aged C 18 years) or adolescents (aged 12-17 years) with a dermatologist-confirmed diagnosis of AA and who had experienced at least 6 weeks of hair loss. In addition, recruitment targets were applied to achieve a mix of participants with the following conditions: C 25% scalp hair loss as measured by the Severity of Alopecia Tool (SALT) [9] within the past 30 days; alopecia totalis (AT), defined as complete (100%) scalp hair loss; and alopecia universalis (AU), defined as complete (100%) scalp, facial, and body hair loss [10][11][12]. Patients were ineligible if they were participating in a clinical trial, undergoing treatment with a Janus kinase (JAK) inhibitor in the past 90 days, or had other forms of alopecia.…”

Management of skin adverse reactions in oncology

“…Burroway et al noted that no therapy, including diphenylcyclopropenone, systemic immunosuppressants, topicals, or combined treatment was associated with improved long-term prognosis. 95…”

Combining 308-monochromatic excimer phototherapy with monthly IM triamcinolone acetonide for the treatment of resistant alopecia totalis

“…Approximately 2% of the world population has alopecia areata (AA), but its prevalence significantly differs by region [1] . Alopecia totalis (AT) is a severe variety of alopecia with more dramatic features and a poor prognosis [2] . Refractory alopecia totalis can be defined as alopecia with unsatisfactory response to systemic treatment or topical immunotherapy.…”