ORIGINAL ARTICLE Alopecia areata totalis and universalis: a multicenter review of 132 patients in Spain S. Va~ n o-Galv an, 1, * P. Fern andez-Crehuet, 2 R. Grimalt, 3 M.J. Garcia-Hernandez, 4 R. Rodrigues-Barata, 5 S. Arias-Santiago, 6 A. Molina-Ruiz, 7 E. Garcia-Lora, 8 J. Dominguez-Cruz, 9 A. Brugues, 10 J. Ferrando, 10 C. Serrano-Falc on, 11 S. Serrano, 12 J. Paoli, 13 F. Camacho 4 1 Dermatology Service, Trichology Unit, Ramon y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain 2 Dermatology Service, Hospital Universitario Reina Sof  ıa, Instituto Maim onides de Investigaci  on Biom edica (IMIBIC), C ordoba, Spain 3 Universitat Internacional de Catalunya, Barcelona, Spain 4 Virgen Macarena, Sevilla, Spain 5 Grupo Pedro Ja en, Madrid, Spain 6 Unidad de Gesti  on Cl  ınica de Dermatolog  ıaM edico-Quir urgica y Venereolog  ıa, Hospital Universitario Virgen de las Nieves, Granada, Spain 7 Fundaci  on Jim enez-Diaz, Madrid, Spain 8 Dermatology Department, Hospital Virgen de las Nieves-Granada, Madrid, Spain 9 Virgen del Roc!ıo, Sevilla, Spain 10 Clinic-Barcelona, Barcelona, Spain 11 Dermatology Service, Hospital de Guadix de Granada, Granada, Spain 12 Dermatology Department, Universidad de Granada, Granada, Spain 13 Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden *Correspondence: S. Va~ n o-Galv an. E-mail: drsergiovano@gmail.com Abstract Background Alopecia areata totalis (AAT) and universalis (AAU) pose a therapeutic challenge. Objective To describe the clinical and epidemiological features, therapeutic response and prognostic factors in a large series of patients diagnosed with AAT and AAU. Methods 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. Results 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. Conclusions 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. Received: 20 January 2016; Accepted: 5 August 2016 Conflicts of interest None declared. Funding sources None declared. © 2016 European Academy of Dermatology and Venereology JEADV 2016 DOI: 10.1111/jdv.13959 JEADV