Acupuncture for Alopecia areata: How effective is it?

Acupuncture for Alopecia areata

My basic premise for treating hair loss is that if something is effective I'd like to know about it and I'd like to be able to offer if to patients.  Having lived in one of the most diverse and multicultural cities in the world, I've come to learn a whole lot about many different types of hair loss treatments.

So what about acupuncture?

I think acupuncture is far less effective in treating alopecia areata than standard treatments. the biggest problem with published studies in alopecia areata is:

In alopecia areata, hair grows back on its own anyways in many patients - so unless a placebo group is included it's difficult to state the benefit of any particular treatment.

To date, I have not seen good evidence in any patient that acupuncture has a beneficial effective in treating most types hair loss. Alopecia areata is the one exception where a very very small effect could be seen - but only in a small proportion of patients. This may be because trauma to the scalp itself can stimulate hair growth in alopecia areata. Even scratching the scalp can trigger hair group. I do feel strongly that acupuncture is less effective than tradition immunosuppressive and immunomodulatory treatments. I feel there is little doubt about this fact.  If a patient with 1-2 small patches of alopecia areata wishes to wait before treatment that is fine - as the patch may grow back even without treatment. If a patient with 1-2 small patches of alopecia areata wishes to do acupuncture - that is fine as it is safe (in the proper clinical setting) and the patch may grow back even without treatment. 

For larger and more extensive patches, I see little to no value in acupuncture as the primary treatment. A large study is now underway (Lee et al see below) retrospectively looking at the benefits of acupuncture. If it proves beneficial, I'll welcome the treatment. Current evidence, however,  would suggest that for more advanced alopecia areata,  other treatments are considerably more effective. None of the current published treatment algorithms for alopecia areata contain any mention of acupuncture. 

REFERENCE

1. Lee HW, et al. Acupuncture for treating alopecia areata: a protocol of systematic review of randomised clinical trials. BMJ Open. 2015.

2. Zhu et al. Clinical observation on acupuncture treatment of alopecia areata. Journal of Acupuncture and Tuina Science. June 2011, Volume 9, Issue 3, pp 162