Alopecia Totalis & Universalis

Both are advanced forms of alopecia areata, an autoimmune condition in which the immune system targets hair follicles. Alopecia totalis is the complete loss of scalp hair. Alopecia universalis is the loss of all scalp and body hair, including eyebrows and eyelashes.

The follicles are usually not destroyed, so regrowth remains possible. It isn't contagious, and it isn't caused by anything you did.

Alopecia areata most often begins before age 40. When widespread hair loss starts after 50 or 60, doctors usually want to rule out other causes first — thyroid problems, low iron, vitamin D or B12, side effects of new medicines, and other autoimmune conditions.

Some scarring types of hair loss, such as frontal fibrosing alopecia, are more common after menopause and can look similar at first. A careful scalp exam — sometimes a small biopsy — helps tell them apart.

Since 2022, a group of oral medicines called JAK inhibitors — baricitinib (Olumiant), ritlecitinib (Litfulo) and deuruxolitinib (Leqselvi) — has been approved for severe alopecia areata. Some people see meaningful regrowth.

These medicines carry boxed safety warnings about serious infections, heart events, blood clots and some cancers, with higher risk in people over 50 who have heart risk factors. For older adults, the conversation about benefits and risks really matters.

Many people also choose wigs, eyebrow and lash options, or simply going without. Every choice is valid.

Without hair, the scalp burns easily — a hat or sunscreen helps. Losing eyelashes can let dust into the eyes, so glasses outdoors can make a difference. Peer support groups, such as the National Alopecia Areata Foundation and the Canadian Alopecia Areata Foundation, can help with the emotional side.