Does Microneedling Help with All Types of Alopecia, or Only Androgenic Alopecia?

Microneedling has become one of the most discussed procedures for hair regrowth in recent years. Originally developed for skin rejuvenation, this minimally invasive technique involves puncturing the scalp with fine needles to create controlled micro-injuries. These micro-injuries stimulate healing responses that include increased collagen production, enhanced blood flow, and the release of growth factors—all of which may support hair follicle activity. But a critical question remains: does microneedling work for all types of alopecia, or only for androgenic alopecia (pattern hair loss)?

Why Microneedling Caught Attention for Hair Loss

Microneedling gained attention after several studies demonstrated its potential to enhance the absorption of topical treatments like minoxidil and to stimulate stem cell activity around hair follicles. The micro-injuries activate platelets and growth factors such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF), all of which play roles in hair cycle regulation.

These mechanisms make sense in theory—but their effectiveness depends on the type of alopecia being treated. Hair loss is not a single disease but a group of conditions with very different causes, from hormone sensitivity to autoimmune attack. Therefore, the same treatment may not work across the board.

Microneedling and Androgenic Alopecia: The Strongest Evidence

The strongest and most consistent evidence for microneedling exists for androgenic alopecia (AGA), also known as male or female pattern baldness. AGA occurs when hair follicles gradually shrink due to sensitivity to dihydrotestosterone (DHT), a derivative of testosterone.

These studies support microneedling as an adjunct therapy in androgenic alopecia, not necessarily as a standalone cure.

Microneedling in Alopecia Areata: A More Complex Story

Alopecia areata (AA) is an autoimmune condition in which the immune system attacks the hair follicles, causing patchy or diffuse hair loss. Unlike AGA, it is not driven by hormones but by immune dysregulation. Theoretically, microneedling could modulate immune responses by triggering wound-healing cytokines, but this idea remains under investigation.

What About Scarring Alopecias?

Scarring alopecias (such as lichen planopilaris or frontal fibrosing alopecia) involve permanent destruction of hair follicles due to chronic inflammation and fibrosis. Once the follicle is replaced by scar tissue, regrowth becomes biologically impossible.

Thus, in scarring alopecia, microneedling offers cosmetic benefits only, such as improved skin quality, but cannot restore hair once follicles are destroyed.

Microneedling Alone vs. Combination Treatments

Research consistently shows that microneedling works best when combined with topical agents such as minoxidil or platelet-rich plasma (PRP). The reason lies in enhanced permeability of the scalp—the microchannels formed by needles allow deeper and more efficient absorption of therapeutic substances.

However, standalone microneedling without adjunct therapies yields modest or temporary effects, especially in androgenic alopecia. The frequency, needle depth, and post-procedure care also critically influence outcomes.

Final Verdict: Not All Alopecias Respond Equally

Microneedling clearly benefits androgenic alopecia, where hair follicles remain viable but are hormonally miniaturized. It may assist in alopecia areata by enhancing topical drug absorption, but it is not an independent or predictable therapy. In scarring alopecias, evidence suggests no regenerative potential at all.

Therefore, microneedling is not a universal solution for all types of alopecia. Its success depends on the cause of hair loss, the presence of active follicles, and whether it is paired with evidence-based topical or injectable treatments.

References

• Dhurat, R., Sukesh, M., Avhad, G., Dandale, A., Pal, A., & Pund, P. (2013). A randomized evaluator-blinded study of effect of microneedling in androgenetic alopecia: A pilot study. International Journal of Trichology, 5(1), 6–11. https://pubmed.ncbi.nlm.nih.gov/24139964/

• Faghihi, G., Iraji, F., Asilian, A., & Adibi, N. (2022). The efficacy of microneedling for androgenetic alopecia: A meta-analysis of randomized controlled trials. Journal of Cosmetic Dermatology, 21(5), 2023–2033. https://pubmed.ncbi.nlm.nih.gov/35638871/

• Firooz, A., Nejad, S. B., & Ghaninezhad, H. (2020). Microneedling combined with corticosteroid therapy for patchy alopecia areata: A pilot study. Journal of Dermatological Treatment, 31(6), 598–603. https://pubmed.ncbi.nlm.nih.gov/32476252/

• Shapiro, J., & Miteva, M. (2021). Microneedling and its potential role in cicatricial alopecias: A review. Dermatologic Therapy, 34(5), e15067. https://pubmed.ncbi.nlm.nih.gov/34324389/