Alopecia is defined as hair loss or baldness. There are several types of alopecia. Alopecia areata is characterized by round patches of complete baldness. Androgenetic alopecia affects approximately 50% of the male population. Modern science still does not have a treatment to completely reverse androgenetic alopecia in advanced stages, Treatment with finasteride, minoxidil, or a combination of both, can stop and partly reverse the hair loss in the majority of patients who have mild to moderate androgenetic alopecia.

Natural Treatment for Alopecia Areata (see the studies at bottom of page)
Very little research has been done regarding diet or supplements for alopecia areata. I present some preliminary findings and you can discuss with your doctor if these options are acceptable for your case.

Genisitein has been evaluated in rodents.
Topical onion juice has shown benefits, however the odor may prevent many people from using this approach.
Massage, relaxation, and stress reduction could be helpful.

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Alopecia Areata
A wide range of clinical presentations can occur with alopecia areata -- from a single patch of hair loss to complete loss of hair on the scalp (alopecia totalis) or the entire body (alopecia universalis).
     Alopecia areata is relatively benign and often resolves on its own, although its psychosocial impact on children and young adults can be severe. Some form of treatment is usually required. Because current treatments may not show results for 3 to 6 months, reassuring the patient and the parents and informing them about the results that can be expected are an essential part of management. The choice of treatment depends on the patient's age and the extent of alopecia activity.

Cause of Alopecia Areata hair loss
The cause of alopecia areata is not fully. Some studies suggest that alopecia areata is an autoimmune disease in which the body's immune system attacks the hair follicles. Other researchers have linked some cases to stress; and still others have no known cause. It is estimated that the condition affects up to 1.7 percent of the population.
   Alopecia areata is a hair loss disease marked by a focal inflammatory infiltrate of dystrophic anagen stage hair follicles by CD4+ and CD8+ lymphocytes. Although the cause of alopecia areata is thought to be an autoimmune disorder, definitive proof is lacking. Moreover, characterization of the primary pathogenic mechanisms by which hair loss is induced in alopecia areata is limited. Recent research using animal models of alopecia areata has focused on providing evidence in support of a lymphocyte-mediated pathogenic mechanism consistent with alopecia areata as an autoimmune disease.
   Non-blistering skin diseases, such as alopecia areata, vitiligo and psoriasis are increasingly believed to be directly mediated by the activities of autoreactive T cells. Alopecia areata frequently occurs in association with other autoimmune diseases, such as thyroiditis and vitiligo, and autoantibodies to follicular components have been detected. Congenital alopecia has also been documented.

Alopecia Areata treatment
People with alopecia areata lose patches or clumps of their hair, and in some cases may lose all the hair on their head or body,Most patients begin to lose their hair before the age of 20. The condition may improve on its own, it can get worse, or it may improve and then become worse again.
   Among the various therapeutic approaches presently available for alopecia areata, only treatment with contact sensitizers such as diphenylcyclopropenone or squaric acid dibutylester has been shown to be temporarily effective. The use of immune modulating drugs, including corticosteroids and contact sensitizers such as dyphencyprone, are rarely beneficial in the management of this disease. Topical minoxidil is not likely to be helpful. A wig is sometimes worn by those with significant alopecia of the scalp. There is no known alopecia cure at this time.

Alopecia Areata treatment update, 2008
Dr. Mike Sladden of the University of Tasmania in Australia reviewed alopecia treatment studies and opines in The Cochrane Library. He says there is no good treatment for this condition. Current treatments include corticosteroids applied to the skin or taken orally, light-based therapies, and minoxidil (Rogaine). Dr. Mike Sladden concludes after his review that none of the treatments were any better than placebo. Many treatments also had "unpleasant side effects" like itching or unwanted hair growth, Sladden and colleagues note, while none offered any guarantee that hair regrowth will remain after treatment ends. The Cochrane Library, published online April 15, 2008.

Hypnosis for Alopecia Areata
Hypnotherapy may enhance the mental well-being of patients with alopecia areata and it may improve clinical outcome," according to Dr. Ria Willemsen, of Free University in Brussels, and colleagues who write in the Journal of the American Academy of Dermatology. Willemsen's team explored hypnosis as a treatment for 21 individuals with extensive hair loss on 30 percent or more of their scalp that had lasted for at least three months. These patients, all of whom previously failed to respond to treatment with steroids, were followed for anywhere from six months to six years. In most cases, the alopecia areata study participants received hypnosis along with some other medical treatment. During the hypnotherapy sessions, which took place once every three weeks, study participants were given various suggestions, such as to imagine the healing effects of the sun's warmth on their scalp. After treatment with a minimum of just three to four sessions of hypnotherapy, 12 patients experienced hair growth on at least 75 percent of their scalp, and nine of these 12 experienced total hair growth. Five study participants experienced a significant relapse during the follow-up period, four of whom experienced enough hair loss to return them to their pretreatment status. Exactly how hypnosis might stimulate hair growth is unknown. In the past, researchers have shown that the hypnotic suggestion to improve blood flow in the scalp was linked to an actual increase in blood flow and skin temperature of the scalp. Willemsen and colleagues speculate that hypnosis may also indirectly lead to certain immune system changes. It is still controversial whether hypnosis is an effective treatment for alopecia areata. Journal of the American Academy of Dermatology, August 2006.

Alopecia Universalis
Alopecia universalis is defined as absence of all of hair, not only on the scalp, but also on the entire body. Affected individuals are born without eyebrows and eyelashes and never develop axillary or pubic hair. There are hair follicles but they are devoid of hair. The disorder is inherited as an autosomal recessive trait.

Q. I have a 22 year old daughter with alopecia universalis. What do you recommend?
   A. I am not aware of any natural cure for alopecia universalis.

Traction Alopecia
Traction alopecia is usually due to excessive tensional forces being exerted on hair shafts as a result of certain hair styling practices. It is seen more often in women, particularly in East Indian and Black patients.

Androgenic Alopecia -Androgenetic Alopecia
Androgenetic alopecia In men, or male pattern baldness, is recognized increasingly as a physically and psychologically harmful medical condition. Androgenetic alopecia affects at least half of white men by the age of 50 years. Although androgenetic alopecia does not appear to cause direct physical harm, hair loss can result in physical harm because hair protects against sunburn, cold, mechanical injury, and ultraviolet light. Hair loss also can psychologically affect the balding individual and can Influence others' perceptions of him. A progressive condition, male pattern baldness is known to depend on the presence of the androgen dihydrotestosterone - DHT - and on a genetic predisposition for this condition. Medicines, hair transplantation, and cosmetic aids have been used to manage male pattern baldness. Two US Food and Drug Administration-approved hair-loss drugs - the potassium channel opener minoxidil and the dihydrotestosterone synthesis inhibitor finasteride -- are somewhat effective for controlling male pattern baldness with long-term daily use. Regardless of which treatment is chosen for alopecia, defining and addressing the patient's expectations regarding therapy are paramount in determining outcome.

Alopecia Areata and TNF-alpha blockers
Failure of Two TNF-alpha Blockers to Influence the Course of Alopecia Areata.
Skinmed. 2006 Jul-Aug;5(4):177-81. Abramovits W, Losornio M.
Department of Dermatology, Baylor University Medical Center, University of Texas Southwestern Medical School, Dallas, TX
Alopecia areata is a form of hair loss believed to be due to an anti-hair-bulb autoimmune process in which CD4 and CD8 lymphocytes affect the peribulb area. Alopecia universalis is the most severe form of alopecia areata and manifests itself as a complete loss of all body hair. The authors present the case of a 44-year-old psoriasis patient with a 20-year history of alopecia universalis who failed to respond to etanercept in terms of skin psoriasis and alopecia universalis, while reporting improvement in arthropathy. While tumor necrosis factor-alpha inhibitors succeeded in the treatment of some autoimmune disorders, reports of alopecia areata failures and this one of alopecia universalis demonstrate resistance to such treatment. Tumor necrosis factor-alpha inhibitors seem to not represent an effective treatment modality for alopecia universalis.

Alopecia in Adolescents
Androgenetic alopecia in adolescents: A report of 43 cases.
J Dermatol. 2006 Oct;33(10):696-9. Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.
Androgenetic alopecia is the most common type of hair loss in adults, but it also occurs in adolescents, though its prevalence among this younger population is not well established. The purpose of this study was to evaluate the clinical manifestations and endocrine status of adolescent patients with androgenetic alopecia in Korea. This 5-year (January 2001-August 2005) clinical study involved 43 adolescent patients with androgenetic alopecia. Testosterone and dehydroepiandrosterone sulfate (DHEA-S) laboratory studies were undertaken to investigate androgenic hormonal effects. Hair loss severity was categorized using the Hamilton-Norwood and Ludwig classifications. Gender ratio showed a male predominance (M : F, 35:8), and a mean age at onset of 17 years. These adolescent patients showed milder symptoms than adults, and a family history of alopecia was found in 72%, which is greater than that reported in adults, which ranges 30-64%. Seborrheic dermatitis (27%) was the condition most commonly associated with androgenetic alopeciaamong our study subjects, followed in descending order by acne vulgaris and atopic dermatitis. Serum levels of testosterone and DHEA-S were within normal limits, except in one subject.

Finasteride and alopecia in women
Effect of finasteride 5 mg (Proscar) on acne and alopecia in female patients with normal serum levels of free testosterone.
Gynecol Endocrinol. 2007 Mar;23(3):142-5.
In some women with acne or alopecia who have normal serum levels of free testosterone, no clinical improvement can be reached by the classical treatment with antiandrogens, isotretinoids or corticosteroids. Our hypothesis is that some of these women have an excessive activity of the enzyme 5alpha-reductase. We evaluated the subjective benefit of the treatment with finasteride (5 mg/day) in women with normal serum levels of free testosterone suffering from acne or alopecia. Nine of the 12 patients benefited from the finasteride treatment, their symptoms decreased significantly and they felt better psychologically than before the administration of finasteride. The other three patients did not benefit at all from finasteride and reported no change in the extent of the acne or alopecia. Treatment was generally well tolerated, only a few adverse effects were noted. Conclusions. Nine of the 12 patients benefited from the finasteride treatment. This supports our hypothesis of an excessive activity of 5alpha-reductase enzyme in peripheral tissue in these patients. The fact that three of the patients did not realize any change in their symptom severity implies that there must also be other pathways in the genesis of acne and alopecia in women with normal levels of free testosterone.

Alopecia Areata Research
Dietary soy oil content and soy-derived phytoestrogen genistein increase resistance to alopecia areata onset in C3H/HeJ mice.
Exp Dermatol. 2003 Feb;12(1):30-6.
Alopecia areata is a complex, multi-factorial disease where genes and the environment may affect susceptibility and severity. Diet is an environmental factor with the potential to influence disease susceptibility. We considered dietary soy (soya) oil content and the soy-derived phytoestrogen genistein as potential modifying agents for C3H/HeJ mouse AA. Normal haired C3H/HeJ mice were grafted with skin from spontaneous AA affected mice, a method previously shown to induce alopecia areata. Grafted mice were given one of three diets containing 1%, 5% or 20% soy oil and observed for AA development. In a separate study, mice on a 1% soy oil diet were injected with 1 mg of genistein three times per week for 10 weeks or received the vehicle as a control. Of mice on 1%, 5%, and 20% soy oil diets, 43 of 50 mice (86%), 11 of 28 mice (39%), and 2 of 11 mice (18%) developed alopecia areata, respectively. Four of 10 mice injected with genistein and 9 of 10 controls developed alopecia areata. Mice with alopecia areata had hair follicle inflammation consistent with observations for spontaneous mouse alopecia areata, but no significant association was observed between the extent of hair loss and diet or genistein injection. Mice that failed to develop alopecia areata typically experience white hair regrowth from their skin grafts associated with a moderate macrophage and dendritic cell infiltration. Soy oil and derivatives have previously been reported to modify inflammatory conditions. Hypothetically, soy oil compounds may act on C3H/HeJ mice through modulating estrogen-dependent mechanisms and/or inflammatory activity to modify alopecia areata susceptibility.

Onion juice (Allium cepa L.), a new topical treatment for alopecia areata.
J Dermatol. 2002 Jun;29(6):343-6.Sharquie KE, Al-Obaidi HK.
Department of Dermatology and Venereology, Baghdad Teaching Hospital, Iraq.
Alopecia areata is a patchy, non-scarring hair loss condition. Any hair-bearing surface may be involved, and different modalities of treatment have been used to induce hair regrowth. This study was designed to test the effectiveness of topical crude onion juice in the treatment of patchy alopecia areata in comparison with tap water. The patients were divided into two groups. The first group [onion juice treated] consisted of 23 patients, 16 males (69.5%) and 7 females (30.5%). Their ages ranged between 5-42 years with a mean of 22 years. The second group [control; tap-water-treated] consisted of 15 patients, 8 males (53%) and 7 females (46%). Their ages ranged between 3-35 years with a mean of 18.3 years. The two groups were advised to apply the treatment twice daily for two months. Re-growth of terminal coarse hairs started after two weeks of treatment with crude onion juice. At four weeks, hair re-growth was seen in 17 patients (73%), and, at six weeks, the hair re-growth was observed in 20 patients (86.9%) and was significantly higher among males (93%) compared to females (71%). In the tap-water treated-control group, hair re-growth was apparent in only 2 patients (13%) at 8 weeks of treatment with no sex difference. The present study showed that the use of crude onion juice gave significantly higher results with regard to hair re-growth than did tap water, and that it can be an effective topical therapy for patchy alopecia areata.

A case study: massage, relaxation, and reward for treatment of alopecia areata.
Psychol Rep. 1994 Jun;74(3 Pt 2):1315-8. Putt SC, Weinstein L, Dzindolet MT. Department of Psychology and Human Ecology, Cameron University, Lawton, OK
Alopecia areata, a common cause of hair loss, is generally considered the consequence of an autoimmune process. Both physiological and psychological factors have been implicated. Previous studies have not incorporated behavior modification in their treatment designs. In this study, three treatment techniques (hair massage, relaxation procedures, and monetary reward) were applied to a 16-year-old male with a five-year history of alopecia areata. Comparison for seven months without treatment versus seven months with treatment showed that loss of hair was markedly reduced after three months of treatment. During the last four months of the study, new hair growth was evidenced.

Alopecia Areata Question
Q.  I have been suffering with alopecia areata for years (since age 10). It was quite still and it is starting over again. It makes life very difficult. I think it's kind of genetical because my brother got it too. he lost all of his hairs. The only treatment here in France, is cortison injections. It make hair for grow back but they fall again. I have found on the net a new medication and I was wondering if it is something I can try.  I wanted your opinion about it. It is called Thymusil.
   A. A look at the ingredient list reveals it has cimicifuga racemosa (black cohosh), rosmarinus officinalis (rosemary), serenoa repens (saw palmetto), vitex agnus-castus (chaste berry), ginkgo biloba, echinacea, ananas cornosus, allium sativum (garlic), ginger, ginseng, St. John's wort, and valerian. Although each of these herbs has health promoting properties, I have not seen any research supporting their use in alopecia areata, and the website that sells it does not list any research done with this product that has been published in a reputable journal. Therefore, the claims made by the company who sells this product are premature and actually they are not allowed by the FDA to make such claims.

Q. My 8 year old son came down with Alopecia Areata 4 months ago and he has lost approximately 60% of his scalp hair. We are using treatments prescribed by our dermatologist (steroid cream, Protopic cream, UVB light treatments) but nothing has helped so far. Do you have any experience with or heard about the herbal formula called Calosol? I'd appreciate your thoughts on this product.
   A. We have no experience or knowledge of this Calosol product. Plus, we cannot find any research published with Calosol.

Q. Would Propecia help with alopecia areata?
   A. Since this condition is probably due to an immunological factor as opposed to excess DHT, I don't think Propecia has been useful in alopecia areata. Propecia is helpful in receding hairline or baldness from excess androgens.

Q. Is there an alopecia cure with natural supplements?
   A. We are not aware of an alopecia areata cure with supplements or medicines.

Q. I read an article you had, along with other numerous articles on the web, touting "crude onion juice" for hair loss. Is there a difference between "crude onion juice" and just plain onion juice? Where to find "crude onion juice"?
   A. Crude onion juice and onion juice, to the best of our understanding, are the same thing. One can buy onions and create their own juice with a juicer. I am not sure how the researchers in the studies made the onion juice. I suspect it may cause a lot of tearing, though.

Q. The onion juice treatment study sounds so promising. Why has no one followed up or pursued this more thoroughly? Every website lists the same vague description of how it was done. Is this because there is no money to be made from this potential cure? Seems a likely explanation to me. At least we could be told what kind of onions were used. There is such a vast difference in the many types of onions that this would seem to be an important/critical detail. Is there anywhere I can find out more details about the onion juice study?
   A. The onion juice study for alopecia was done in 2002, before the Iraq invasion, at the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Iraq. We have no idea of how stable this hospital is at this time and whether the primary researchers are still alive on in Iraq.

Q. My girlfriend is suffering from congenita alopecia, she don't have any hairs on here body by birth. she is now 25 years old, sir i want to know is there any possible treatment of this disease. if so please describe the treatment, is the treatment is available in Iran. Please sir reply because she is having a lots of problem in here life and on here job.
   A. Sorry, but we are not aware of any cure for congenital alopecia.

Q. there is a site : alopecia-areata dot com in which a Russian doctor is guaranteeing complete regrowth of hair in all the cases of alopecia areata. What is your opinion?
   A. I cannot tell if this is a legitimate site or whether it is a scam. The alopecia areata site does not seem to mention what the treatment is.