Alopecia

What is Alopecia?

Alopecia is the loss of hair from an area where hair is expected to grow. It can be patchy or diffuse, temporary or permanent, and it affects people of all ages and both sexes.^[1] Alopecia is a sign with many possible causes, not a single disease, and it is broadly divided into nonscarring and scarring types.^[1]

Common symptoms

The symptoms depend on the type. Alopecia areata causes smooth, round patches of hair loss and can progress to loss of all scalp hair (alopecia totalis) or of all body hair (alopecia universalis).^[2] Androgenetic alopecia, or pattern baldness, causes gradual thinning. Men tend to lose hair at the temples and crown, while women usually keep the frontal hairline and develop thinning over the top of the scalp.^[3]

Telogen effluvium causes diffuse shedding across the scalp.^[4] Hair loss with itching, redness or scaling can point to an infection or inflammatory scalp condition.^[1]

Causes and risk factors

Alopecia areata is an autoimmune disease in which the immune system attacks the hair follicle, affecting up to 2% of the general population.^[2] Androgenetic alopecia is inherited and results from an exaggerated response to androgens.^[3]

Telogen effluvium is triggered by stress on the body, such as fever, severe infection, surgery, childbirth, thyroid disease, crash dieting, low protein intake or iron deficiency. It can also be caused by some medicines.^[4] Other causes include tight hairstyles, chemotherapy, scalp scarring and fungal infection.^[1]

How it is diagnosed and treated conventionally

A clinician finds the cause from your history, an examination of the scalp and hair loss pattern, and sometimes blood tests or a scalp biopsy.^[1] The correct diagnosis matters because treatment differs sharply between types.

Alopecia areata has been treated with corticosteroids, immunotherapy, minoxidil and, more recently, Janus kinase (JAK) inhibitors. Older treatments have limited effectiveness and recurrence is common.^[2] A Cochrane review of 63 trials found high-certainty evidence that the JAK inhibitor baricitinib increased hair regrowth compared with placebo, and that the evidence for most other treatments was very uncertain.^[5]

For androgenetic alopecia, minoxidil and finasteride are the usual medicines, and hair transplant is an option.^[3] Telogen effluvium often settles once the trigger is removed.^[4]

Why Alopecia calls for a whole-person approach

Hair follicles respond to the immune system, hormones, nutrition and overall health, so hair loss often has more than one contributor. A person with alopecia may also be dealing with the emotional weight of visible hair loss.

Medical treatment targets the follicle and the underlying cause. Looking at the other contributing factors is a reasonable addition, provided it does not delay diagnosis or replace treatment.

Immune activity

In alopecia areata, the leading theory is that the hair follicle loses its normal protection from immune attack.^[2] This is why the condition is managed by physicians with immune-directed treatments.

Hormones and genetics

Androgenetic alopecia depends on inherited sensitivity to androgens.^[3] Hormonal changes, such as those after childbirth or with thyroid disease, can also trigger shedding.^[4]

Stress, mood and quality of life

A systematic review of 73 reports found that people with alopecia areata have more anxiety and depression and a lower quality of life, and concluded that addressing this should be an active part of treatment.^[6] Stress and physical strain on the body are also recognized triggers of telogen effluvium.^[4]

Nutrition

Low iron and low protein intake are recognized triggers of telogen effluvium.^[4] A systematic review of nutritional supplements for hair loss, in people without a known deficiency, found that some products showed potential benefit in higher-quality studies, with rare and mild side effects. The authors urged larger trials with active comparators.^[7] Blood tests ordered by your physician are the way to find out whether you are deficient.

Acupuncture for Alopecia

What the research shows

Most acupuncture research on hair loss concerns alopecia areata, and it is limited by study quality. A 2026 systematic review of 11 randomized trials with 1,144 participants found that adding plum-blossom needling to conventional medicine produced a higher rate of improvement than conventional medicine alone (7 trials, 756 participants). The certainty of the evidence was low, the risk of bias was unclear in most trials, and the sample sizes were small.^[8]

An earlier meta-analysis of 11 trials with 1,192 patients found that adding plum-blossom needling to conventional treatment was associated with more hair regrowth. The study quality was medium or relatively low and the results varied widely between trials.^[9] A narrative review reported that acupuncture and moxibustion were beneficial in alopecia areata, androgenetic alopecia and seborrheic alopecia, but this is a lower level of evidence than a controlled trial.^[10]

We found no sham-controlled trials showing that acupuncture alone regrows hair. These studies mostly compared medicine plus needling with medicine alone, and most were done in China.

How acupuncture may work

Researchers propose that acupuncture may influence the immune system and the brain networks involved in emotion, and may reduce inflammation or lower testosterone levels, depending on the type of hair loss. These are theories, not settled facts.^[10]

What treatment involves

Treatment uses fine, sterile, single-use needles at points chosen for the person, usually left in place for about 20 to 40 minutes. We reassess after a short course of visits. Some research uses plum-blossom needling, in which the scalp is tapped with a small group of needles, which is a form of acupuncture technique.^[8]

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Needling should be avoided on areas of scalp that are infected.

Ayurvedic medicine for Alopecia

The Ayurvedic view

In Ayurveda, patchy hair loss is described as Indralupta, and hair loss in general is linked to aggravated Pitta, with Vata and Kapha involved in some descriptions. These are traditional categories used to choose treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine, with attention to regular meals, adequate protein and sleep, and stress reduction
• Scalp massage with medicated oils
• Herbs traditionally used for hair and scalp health, such as bhringraj (Eclipta), amla and brahmi, prescribed individually by a qualified practitioner
• Panchakarma procedures, only in selected cases

Panchakarma is not appropriate during pregnancy, acute illness or frailty, or in someone whose hair loss has not yet been medically assessed.

What the research shows

The research on Ayurveda for alopecia is very limited. A PubMed search found no controlled trials and no systematic reviews. The only clinical report we found was a single case of alopecia areata, in a patient who had not responded to conventional medicine and who had hospital-based Ayurvedic treatment for more than six weeks with regrowth. A single case cannot show that a treatment works.^[12]

Eclipta, a plant used traditionally for hair loss, has been reported in pharmacology studies to promote hair growth. The authors of a review said the findings are still insufficient and that safety needs study before clinical use.^[13]

Herbal medicine for Alopecia

Herbs and formulas that have been studied

Herbs and plant products studied for hair loss include rosemary, saw palmetto, pumpkin seed oil, green tea, ginseng and aloe vera.^{[14, 15]} Herbal preparations applied to the skin may be offered through our transdermal medication therapy.

What the research shows

The evidence is limited. A systematic review of 16 randomized trials of herbal remedies for hair loss reported promising effects on hair growth, hair density and shedding, but noted design limitations and variable outcomes.^[15] A 2025 review reached a similar conclusion, citing small samples and short follow-up.^[14]

In a trial of 100 people with androgenetic alopecia, rosemary oil and 2% minoxidil produced similar increases in hair count after six months, with less scalp itching in the rosemary group.^[16] A trial of 60 women with female pattern hair loss found that pumpkin seed oil and minoxidil foam both improved scalp findings over three months.^[17] A network meta-analysis of 19 trials found that several supplements, including pumpkin seed oil and some plant extracts, improved hair density compared with placebo, and called for larger trials.^[18]

One review also describes herbal studies in alopecia areata and telogen effluvium, but with the same limits.^[14] The controlled trials described here were in androgenetic alopecia, and these herbs have not been shown to replace proven medical treatment.

Safety and herb-drug interactions

Herbs are active substances and can cause scalp irritation or allergy, and they can interact with medicines. A literature review described interactions between herbs and prescribed drugs, including bleeding with warfarin and changes in drug levels with St John's wort and others.^[19] People taking blood thinners, immune-suppressing drugs or hormonal medicines need a practitioner's review before using herbs.

Some herbs, such as saw palmetto, are used for their possible effect on androgens. If you take finasteride or hormone treatment, tell us so this can be reviewed with your physician. In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes hair loss as a deficiency of blood or of kidney essence, or as blood stasis that does not nourish the hair. Researchers studying acupuncture for hair loss look at things that loosely parallel this picture: immune activity, inflammation, hormone levels and stress responses.^[10]

Ayurveda's aggravated Pitta describes a heated, inflamed state. Herbal research on hair growth points to ideas such as blocking the enzyme that converts testosterone to a stronger androgen, better scalp circulation and antioxidant effects.^[14] No study has shown that a dosha or a pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for alopecia is complementary. Keep your dermatologist or primary care physician, and do not stop or change prescribed medicines, including minoxidil, finasteride, corticosteroids or JAK inhibitors, without your prescriber. We do not diagnose the cause of hair loss, so new or unexplained hair loss should be medically evaluated first.

Please bring your diagnosis, any blood test or biopsy results, a full list of medicines and supplements, and details of past hair loss treatments. Treatments for alopecia areata can take months to show results, and we cannot promise regrowth.

When to seek urgent medical care

See a doctor promptly if hair loss comes on suddenly or with other symptoms.

• Sudden or rapidly spreading hair loss, or loss of eyebrows, eyelashes or body hair
• A red, scaly, painful or pus-draining scalp, or scalp patches with scarring
• Hair loss with unexplained weight change, fatigue, feeling cold, irregular periods or excess facial hair
• Hair loss that begins after starting a new medicine
• Low mood, hopelessness or thoughts of self-harm, which are more common in people with alopecia areata^[6]

For thoughts of suicide, call or text 988. For emergencies, call 911 or go to the nearest emergency department.