Alopecia totalis and alopecia universalis are the most severe forms of alopecia.


Alopecia totalis involves the total loss of all scalp hair, with or without subtotal loss of hair elsewhere.


Alopecia universalis involves loss of all body hair (alopecia totalis and total loss of hair elsewhere).


Conditions associated with severe alopecia include:

(1) confluent alopecia areata (with an underlying autoimmune disorder)

(2) congenital atrichia with papular lesions

(3) severe protein malnutrition

(4) chemotherapy

(5) other severe toxic exposure

(6) inherited metabolic disorder (holocarboxylase synthetase deficiency or vitamin D-resistant rickets Type II)

(7) extreme emotional shock


Identifying the cause is important since this determines the most effective therapeutic approach. Alopecia associated with an underlying autoimmune disorder will often respond to corticosteroids, while the other conditions will not.


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