Got small bald circles with no warning? Centella creams might calm the area and kickstart new growth

Those small, round bald patches that suddenly appear on the scalp can be confusing. Many people, even without any history of hair problems, are surprised to find coin-sized spots with no hair.

The appearance of a "small bald circle" is an important sign to watch. It can point to several different conditions — alopecia areata, which is autoimmune; a fungal scalp infection (tinea capitis); a scarring alopecia; or traction and telogen shedding. These look similar to an untrained eye and are treated very differently, so getting the patch looked at by a clinician is the first real step in understanding what is happening to your scalp.

Alopecia areata, in particular, tends to show up without pain, itching, or any warning. Dermatology guidelines list corticosteroids, topical immunotherapy and, for severe disease, JAK inhibitors as the options with clinical trial evidence behind them. Alongside those, interest has grown in cosmetic products marketed as calming for the scalp. Among these, creams containing Centella asiatica extract are widely discussed by consumers and skincare brands.

Centella asiatica: an ancient plant with new uses

Centella asiatica is a plant native to Asia that has been used for centuries in Traditional Chinese Medicine and Ayurveda for wound healing. In modern dermatology, extracts have been studied mainly for skin barrier repair, irritation and wound healing. Its use on the scalp is much more recent and much less studied — the interest rests on the idea that reducing local inflammation might make a difference, not on trials showing that it does.

Alopecia areata is an autoimmune condition in which the immune system attacks hair follicles and disrupts the hair growth cycle. The exact cause is unclear; it has been linked to genetic predisposition, stress, and other autoimmune conditions such as thyroid disease and type 1 diabetes. The hallmark signs are its sudden onset and the round shape of the bald patches, which may expand or, in some cases, resolve on their own.

What happens to the follicles when bald circles appear?

When these bald patches form, the hair follicles do not disappear. Instead, they are pushed into a resting phase by the immune attack. The follicle bulb is not necessarily destroyed but is severely disrupted. If the inflammation settles, follicles can reactivate and produce hair again. That does not happen in every case, and dermatologists commonly treat alopecia areata with prescription medication rather than waiting.

Centella creams: just a trend or scientifically supported?

Many Centella products are advertised as if they were treatments, so it is worth separating what has been tested from what has been marketed. There is no published human trial of Centella asiatica — as a cream, a serum or an oral extract — for alopecia areata or for any other form of hair loss. What exists is laboratory work on isolated cells.

In a 2017 paper in Bioscience, Biotechnology, and Biochemistry, researchers applied a titrated extract of Centella asiatica to human dermal papilla cells grown as three-dimensional spheroids. The extract increased spheroid size and the expression of hair-growth-related genes, and suppressed STAT signalling in those cells. A 2024 paper in Frontiers in Pharmacology reported comparable in-vitro effects for araliadiol, a compound found in Centella asiatica, in cultured human hair-follicle stem cells and dermal papilla cells.

Both are cell-culture studies. Neither used animals or people, neither applied a cream to a scalp, and neither looked at alopecia areata. Results in cultured cells often do not reproduce in humans, so they cannot tell you whether a Centella cream will regrow hair in a bald patch.

What's the difference between minoxidil drops and Centella cream?

Minoxidil is a vasodilator that acts on hair follicles by prolonging their growth phase (anagen) and increasing follicle size. It has been tested in large human trials, and topical minoxidil is FDA-approved for androgenetic alopecia — male and female pattern hair loss — only. It is not approved for alopecia areata, although dermatologists sometimes use it off-label alongside other treatments.

Centella has no established mechanism on the hair cycle. The proposed effects are indirect — reducing inflammation and irritation in the skin — and they have been demonstrated in skin research rather than in hair-loss patients.

So the two are not comparable products. Minoxidil is a licensed medicine with trial data; a Centella cream is a cosmetic that may make the scalp feel more comfortable.

Examples of Centella creams on the market

Centella-based creams are sold widely for skin and scalp care. Commonly mentioned examples include Madecassol (Bayer), marketed as a healing cream and widely sold in South Korea; Cicapair by Dr. Jart, sold as a calming facial treatment; and Skin1004 Madagascar Centella Soothing Cream, marketed for sensitive or redness-prone skin.

These are the manufacturers' own marketing claims — anti-inflammatory, calming, regenerative — and they are made about skin, not about hair loss. None of these products is approved or tested as a treatment for alopecia areata, and being sold as gentle or natural says nothing about whether it will regrow hair.

User Experiences

In discussions on Tressless, a few users have shared insights that touch directly on the question of using Centella asiatica (often found in skin-calming creams) for sudden-onset bald spots, such as alopecia areata or post-surgical scalp trauma. One user posted about experiencing large bald areas in the donor region after a hair transplant and described using a combination of La Roche-Posay's B5 Centella cream and thermal water to soothe the irritated scalp. They mentioned that it helped reduce inflammation, although they didn't report substantial regrowth directly from the Centella itself. The post also referenced concerns about scalp necrosis and inflammation, which are serious conditions that sometimes occur after transplants or due to infection and need urgent medical attention. Other users responded recommending anti-inflammatory and healing-focused topicals, including those containing Centella, particularly for scalp recovery. However, no user explicitly confirmed new hair growth attributed to Centella alone.

Another discussion involved exosomes, including those derived from Centella asiatica. A few users were curious about their role in stimulating hair growth, with some skepticism. One user compared them to conventional treatments like finasteride, noting that while Centella-based exosomes might be promising, there was not yet strong evidence or visible results from the community to support their effectiveness as a standalone hair growth stimulant.

Overall, while Centella-based products were viewed positively for reducing scalp irritation and supporting recovery, user feedback does not support the claim that these creams alone can trigger new hair growth in bald patches. The general sentiment is that they may help calm inflammation, especially after a procedure or during an inflammatory episode, but that stronger treatments are what community members credit for regrowth.

So, back to the original question: can Centella creams calm the area affected by alopecia areata and possibly stimulate hair regrowth?

On the calming half, community reports and the wider skin research are consistent with a soothing effect on an irritated scalp. On the regrowth half, there is no human evidence at all — only cell-culture work, and none of it in alopecia areata. Treated as a gentle skincare product, a Centella cream is low-risk. Treated as a treatment for bald patches, it is untested, and using it instead of getting a diagnosis can let a treatable condition run.

Sudden round bald patches are a presentation that needs a diagnosis rather than a cosmetic, because several different conditions produce them and some cause permanent scarring if left. Talk to a doctor, pharmacist or dermatologist before treating a new bald patch yourself, and before starting, stopping or combining any hair-loss medication.

References

Choi, Y. M., An, S., Lee, J., Lee, J. H., et al. (2017). Titrated extract of Centella asiatica increases hair inductive property through inhibition of STAT signaling pathway in three-dimensional spheroid cultured human dermal papilla cells. Bioscience, Biotechnology, and Biochemistry, 81(12), 2323–2329. https://pubmed.ncbi.nlm.nih.gov/29032741/

Park, S., Park, H. W., Seo, D. B., & Yoo, D. S. (2024). In vitro hair growth-promoting effects of araliadiol via the p38/PPAR-γ signaling pathway in human hair follicle stem cells and dermal papilla cells. Frontiers in Pharmacology, 15, 1482898. https://pubmed.ncbi.nlm.nih.gov/39691387/

Tressless. (2023, December 21). Huge holes on donor area of scalp is this even normal? Reddit. https://reddit.com/r/tressless/comments/18nvl4b/huge_holes_on_donor_area_of_scalp_is_this_even/

Tressless. (2025, January 22). Exosomes 2 months before and after. Reddit. https://reddit.com/r/tressless/comments/1i7bgzj/exosomes_2_months_before_and_after/