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J Eur Acad Dermatol Venereol. 2016 Oct 6. doi: 10.1111/jdv.13959. [Epub ahead of print]

Alopecia areata totalis and universalis: a multicenter review of 132 patients in Spain.

Author information

  • 1Dermatology Service, Trichology Unit, Ramon y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain.
  • 2Dermatology Service, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica (IMIBIC), Córdoba, Spain.
  • 3Universitat Internacional de Catalunya, Barcelona, Spain.
  • 4Virgen Macarena, Sevilla, Spain.
  • 5Grupo Pedro Jaén, Madrid, Spain.
  • 6Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
  • 7Fundación Jiménez-Diaz, Madrid, Spain.
  • 8Dermatology Department, Hospital Virgen de las Nieves-Granada, Madrid, Spain.
  • 9Virgen del Roc!ıo, Sevilla, Spain.
  • 10Clinic-Barcelona, Barcelona, Spain.
  • 11Dermatology Service, Hospital de Guadix de Granada, Granada, Spain.
  • 12Dermatology Department, Universidad de Granada, Granada, Spain.
  • 13Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.



Alopecia areata totalis (AAT) and universalis (AAU) pose a therapeutic challenge.


To describe the clinical and epidemiological features, therapeutic response and prognostic factors in a large series of patients diagnosed with AAT and AAU.


This retrospective multicenter study included patients diagnosed with AAT/AAU with a minimum follow-up of 12 months. Response was assessed based on the regrowth of scalp hair.


In all, 132 patients (92 women and 40 men) - 80 (61%) diagnosed with AAU and 52 (39%) diagnosed with AAT - were included. The median time between the presentation of alopecia areata (AA) and the development of extensive AA was 1 year and it was less than 4 years in 121 patients (91%). There was an initial response to treatment in 64% of patients, although only 14% presented a persistent response. Adverse side effects from the medications used were detected in 33% of patients. The prognostic factors associated with poor response were the presence of AAU and a positive family history of AA.


Treatment of AAT and AAU is challenging. Although an initial regrowth may be achieved, the duration of response is usually short. There were no significant differences on the effectiveness or duration of response between the various systemic therapies.

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