Alopecia Totalis: Is It a Skin Issue or a Hair Loss Condition?

A woman is indoors in her living room. Her head is shaved due to chemotherapy. She is sitting and looking thoughtful.


Alopecia is the general medical term for any type of hair loss, and alopecia areata is the most common form of an unusual autoimmune skin disease resulting in patchy hair loss on the scalp. But when hair loss extends to the total scalp, resulting in baldness, the disease is called alopecia totalis.

According to the National Alopecia Areata Foundation (NAAF), alopecia areata affects approximately 2 percent of the overall U.S. population, or more than 5 million people. In the 1990s the disease was classified as an autoimmune disease because researchers found that it is the result of the body producing an inappropriate immune response against itself. And while the cause of this autoimmune disease is unknown, many hair loss specialists have noticed a link between sudden stress and the onset of the disease, which very typically occurs in childhood, although it can occur in males and females of any age.

Alopecia totalis is considered a skin disease because it occurs on the skin of the head, or scalp, and is usually diagnosed by a dermatologist. Experts agree that as troubling as it is to lose your hair, the disease does not include any type of physical illness, rashes, hives or itching, although a totally exposed scalp does require extra care from exposure to the elements, especially the sun.

If alopecia totalis is an “autoimmune disease” what does “autoimmune” mean?

According to the Johns Hopkins Medical Institutions Autoimmune Disease Research Center, a healthy human body’s immune system is composed of an effective set of weapons against viruses, bacteria and parasites that can attack the body. Unfortunately, the immune system sometimes mistakenly attacks the body itself, and these misdirected immune responses are called autoimmunity. In alopecia totalis, all the hair follicles on the scalp are mistakenly being attacked by one’s own immune system, resulting in the total loss of hair on the head, although one’s overall health remains unaffected.

There is no known cure for the condition, but the hair follicles on the head are unharmed and remain alive and ready to resume normal hair production whenever they receive the appropriate signal. According to the NAAF, hair regrowth may occur even without treatment and even after many years.

Is alopecia totalis in my genes?

Experts believe there is a genetic component to the different forms of alopecia areata, including alopecia totalis, because one out of five people with symptoms have a family member also affected by hair loss. Current research indicates that if onset begins after age 30, you are less likely to have an affected family member; when onset of any type of alopecia begins before age 30, it is more likely that other family members as well are affected. The NAAF has focused a lot of its research into investigating the genetic elements of the disease in order to eventually identify who is most susceptible to the disease and why.

Treatment options for alopecia totalis

According to the NAAF, there are no FDA-approved treatments specifically for alopecia totalis; however, many medical professionals are willing to try treatments off-label, especially for the patchy scalp hair loss of alopecia areata, but none of the acceptable treatments work in all cases. Currently, researchers are experimenting with stem cell and platelet infusions and injections to stimulate the hair growth cycle in cases of alopecia areata.

The quickest fix — a nonsurgical hair system

There are beautiful medical-grade hair replacement options that are the most natural, comfortable choice for replacing the hair on your head and helping you feel better about your condition on a daily basis. These include wigs meant to be worn on a completely bald scalp, without slipping. They have a monofilament cap that lets your real scalp show through, as if the hair were growing right out of it. Budget permitting, you can also choose hand-tied knots, which move in many directions just like real hair, unlike machine-made wefts, which move in only one direction. Visit a hair loss specialist, who can match your previous hair color, texture and style quickly with a medically necessary hair replacement wig to cover your alopecia totalis, beautifully and naturally.