Alopecia is defined as hair loss or baldness. There are several types. Alopecia areata is characterized by round patches of complete baldness. People with this condition lose patches or clumps of their hair, and in some cases may lose all the hair on their head or body.  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 mild to moderate symptoms and signs.

Natural treatment for alopecia areata
Very little research has been done regarding diet or supplements. I present some preliminary findings and you can discuss with your doctor if these options are acceptable for your case. I am currently not aware of a natural cure. Massage, relaxation, and stress reduction could be helpful.

Alopecia Areata research with natural foods and supplements
Garlic could be of benefit, it is not clear whether oral ingestion works as does topical application.
   Indian J Dermatol Venereol Leprol. 2007. Combination of topical garlic gel and betamethasone valerate cream in the treatment of localized alopecia areata: a double-blind randomized controlled study. Patients were randomly divided into two groups of garlic gel and placebo. The two groups were advised to follow the treatment twice daily, for three months. Both groups received topical application of corticosteroid (betamethasone cream 0.1%) twice daily.  The first group (garlic treated) consisted of 20 patients. The second group (control) consisted of 20 patients. At the end of the treatment, good and moderate responses were observed in 19 (95%) and one (5%) patients of the case group respectively, which was significantly better than the control group. No complication was observed in the patients under study. The present study showed that the use of garlic gel significantly added to the therapeutic efficacy of topical betamethasone valerate in alopecia areata and that it can be an effective adjunctive topical therapy for alopecia areata.

Genisitein, a phytoestrogen, has been evaluated in rodents.

Dietary supplements
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 review of 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.

Onion juice (Allium cepa), a new topical treatment for alopecia areata
Topical onion juice has shown benefits, however the odor may prevent many people from using this approach.

J Dermatolofy. 2002. Department of Dermatology and Venereology, Baghdad Teaching Hospital, Iraq.
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 and 7 females. 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 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%) 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.

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. I read an article 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 my 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.

Alopecia Areata symptoms, how it starts
There is often a sudden onset of patchy nonscarring hair loss that is often associated with spontaneous regrowth within 1 to 3 months. A prodrome of mild paresthesias, pruritus, tenderness or a burning sensation may precede hair loss but often times the hair loss comes without symptoms. Ninety-five percent of cases involve the scalp.

Most people with the condition 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. A wide range of clinical presentations can occur -- 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 the condition.

Cause of hair loss
The cause of alopecia areata is not fully. Some studies suggest that it 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.
   This disease marked by a focal inflammatory infiltrate of dystrophic anagen stage hair follicles by CD4+ and CD8+ lymphocytes. Although the cause is thought to be an autoimmune disorder, definitive proof is lacking. Moreover, characterization of the primary pathogenic mechanisms by which hair loss is induced is limited. Recent research using animal models 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. This condition 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.

Nat Med. 2014. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Alopecia areata (AA) is a common autoimmune disease resulting from damage of the hair follicle by T cells. The immune pathways required for autoreactive T cell activation in AA are not defined limiting clinical development of rational targeted therapies. Some patients treated with oral ruxolitinib, an inhibitor of JAK1 and JAK2, achieved near-complete hair regrowth within 5 months of treatment, suggesting the potential clinical utility of JAK inhibition in human AA.

Emotional or psychological trauma
Adults who have alopecia areata are more likely to have experienced traumatic life events in childhood or at any time in their life than adults without this hair loss condition. Dr. Ria Willemsen, of Universitair Ziekenhuis Brussel says additional interest in the stress theory has emerged because it has been proven by a group of German researchers that stress can lead to alopecia areata in mice. In their study, Dr. Ria Willemsen and colleagues asked 90 people with alopecia areata and 91 without the condition about their history of traumatic events. They found that significantly more alopecia patients than control subjects reported at least one lifetime traumatic event (87 percent vs 73 percent). In addition, significantly more alopecia patients (42 percent) than controls (25 percent) reported experiencing at least one traumatic event in childhood, especially emotional neglect and abuse within the family. Journal of the American Academy of Dermatology, 2009.

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
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, 2008.

Columbia University Medical Center researchers found that the drug ruxolitinib (brand name: Jakafi) restored hair growth in a small number of patients with alopecia areata, a disease in which immune cells destroy hair follicles. Columbia University, news release, Aug. 17, 2014. There are several Food and Drug Administration-approved JAK inhibitors, including ruxolitinib, or Jakafi and tofacitinib, sold under the brand name Xeljanz. Because they suppress the immune system, leaving patients vulnerable to infections, it would be dangerous to use them to correct something cosmetic like male pattern baldness.

Alopecia Universalis
This 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.

2014 - Yale University School of Medicine announced the first reported successful targeted treatment of alopecia universalis. The subject of the study, a 25-year-old man grew back his eyebrows, eyelashes, and other hair after an eight-month course of tofacitinib.

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

Traction Alopecia information
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
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.

Natural supplements, herbs, vitamins for androgenetic alopecia
Beta sitosterol and saw palmetto have been studied.

TNF-alpha blockers
Failure of Two TNF-alpha Blockers to Influence the Course of Alopecia Areata.
Skinmed. 2006. 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. Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.
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 clinical study involved 43 adolescent patients with androgenetic alopecia. Testosterone and dehydroepiandrosterone sulfate (DHEA-S) laboratory studies were undertaken to investigate androgenic hormonal effects. 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.
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.

A case study: massage, relaxation, and reward for treatment of alopecia areata.
Psychol Rep. 1994. Department of Psychology and Human Ecology, Cameron University, Lawton, OK
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.

Question
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. My girlfriend is suffering from congenital 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.

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?
    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.

Is Vitacel GH7 Plus with Procaine a viable supplement to help alopecia sufferers? Would like to know if Vitacel GH7 Plus with Procaine claims can be verified and if the company is legitimate.
    We have not seen any published research with this product on Medline as of 2012.

 Q. I have had Alopecia for the last 25 years. Blood tests have revealed low pregnenolone levels, and Testosterone levels at the very low end of the normal range. My doctor has prescribed 60mg daily of pregnenolone along with 1ml daily of 50 mg/ml Testosterone x 50 mg/ml Chrysin cream.
   A. There can be serious adverse reactions to the high dosages of these hormones.

Q. My 14 yr old daughter just lost all of her beautiful long brown hair to alopecia. It has been devastating and frustrating to find there is no definitive reason for this. My main problem is figuring out what treatments to try and stick with as there are SO many possible things with no definitive answer. The doctor at Children’s hospital has prescribed methyltrexate, an immunosuppressant, right as we head into cold and flu season. I was really more interested in Jax inhibitor from her but ended up with the methyltrexate. I am not sure whether to continue this or not. She is also seeing a naturopath who is targeting adrenal glands, thyroid support and inflammation as well as restricting her diet to whole foods, no gluten, dairy, sugar. So far, no sign of hair regrowth but we just lost most of it recently and we just shaved the remaining hair off just a few days ago (so sad).
   A. If I find more information on this topic I will definitely publish it.

References
Exp Dermatology. 2003. Dietary soy oil content and soy-derived phytoestrogen genistein increase resistance to alopecia areata onset in C3H/HeJ mice. We considered dietary soy (soya) oil content and the soy-derived phytoestrogen genistein as potential modifying agents for mouse AA. Normal haired 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, 11 of 28 mice, and 2 of 11 mice 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.