Treating Alopecia Areata Totalis/Universalis
While there is no Food & Drug Administration (FDA) approved treatment for alopecia areata, some medical professionals will treat your alopecia areata off-label. However, fewer treatment options are available for extensive alopecia areata (greater the 50% scalp hair loss).
Cortisone pills: Cortisone pills are sometimes given for extensive scalp hair loss. Cortisone taken internally is much stronger than local injections of cortisone into the skin. It is necessary to discuss possible side effects of cortisone pills with your physician. Healthy young adults often tolerate cortisone pills with few side effects. In general, however, cortisone pills are used in relatively few patients with alopecia areata due to health risks from prolonged use. Also, regrown hair is likely to fall out when the cortisone pills are stopped.
Topical Immunotherapy: Another method of treating extensive alopecia areata or alopecia totalis/universalis is known as topical immunotherapy and it involves producing and allergic rash or allergic contact dermatitis. Chemicals such as diphencyprone (DPCP), dinitrochlorobenzene (DNCB), or squaric acid dibutyl ester (SADBE) are applied to the scalp to produce an allergic rash which resembles poison oak or ivy. Approximately 40% of patients treated with topical immunotherapy will regrow scalp hair after about six months of treatment. Those who do successfully regrow scalp hair still need to continue the treatment to maintain the hair regrowth, at least until the condition turns itself off. An itchy rash may be uncomfortable in very hot weather, especially under a wig. These treatments are not available everywhere in the United States although they are used frequently in Canada and Europe.
Wigs: In general, treatments are much less effective for extensive alopecia areata (particularly alopecia totalis/universalis). For this reason, an attractive wig is an important option for some people. Proper attention will make a quality wig look completely natural; every wig has to be cut, thinned and styled, often several times. To keep a net base wig from falling off, even during active sports, special double sided tape can be purchased in beauty supply outlets and fastened to the inside of the wig.
For those with completely bare heads, there are suction caps to which any wig can be attached and there are entire suction cap wig units. These state of the art wigs, which make use of a silicon base to create a secure vacuum-fit, are comfortable and easily removed by the wearer. Proper fit of a vacuum wig requires that any existing scalp hair be shaved. These wigs are generally more expensive than other types of wigs.