The Journal of Dermatology

Vol. 29: 343346, 2002

Onion Juice (Allium cepa L.), A New Topical Treatment

for Alopecia Areata
Khalifa E. Sharquie and Hala K. Al-Obaidi

Abstract
Alopecia areata is a patchy, non-scarring hair loss condition. Any hair-bearing surface
may be involved, and different modalities of treatment have been used to induce hair re-
growth. 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 divid-
ed into two groups. The first group [onion-juice treated] consisted of 23 patients, 16 males
(69.5%) and 7 females (30.5%). Their ages ranged between 5-42 years with a mean of 22.7
years. The second group [control; tap-water-treated] consisted of 15 patients, 8 males
(53.3%) and 7 females (46.6%). Their ages ranged between 335 years with a mean of
18.3 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 (73.9%), and, at six weeks, the
hair re-growth was observed in 20 patients (86.9%) and was significantly higher among
males (93.7%) compared to females (71.4%) P<0.0001. 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 signif-
icantly higher results with regard to hair re-growth than did tap water (P<0.0001), and that
it can be an effective topical therapy for patchy alopecia areata.
Key words: alopecia areata; onion juice

zene, squaric acid dibutylester, diphenylcy-

Introduction
Alopecia areata is a common skin disease
that is probably induced by an autoimmune
mechanism (1). Many therapies (2) have
been tried to induce hair growth, including
non-specific irritants such as phenol and
dithranol, immune inhibitors such as topi-
cal and systemic steroids, PUVA, and cy-
closporine; immune enhancers such as topi-
cal immunotherapy by dinitrochloroben-
Received May 11, 2001; accepted for publication
February 12, 2002
Department of Dermatology and Venereology,
Baghdad Teaching Hospital, Baghdad, Iraq.
Reprint requests to: Khalifa E. Sharquie, Professor
and Chairman of Dermatology and Venereology De-
partment, College of Medicine, University of Bagh-
dad, P.O.Box 61080, Postal code number 12114,
Medical collection post office, Baghdad, Iraq.
clopropenone, and inosiplex; and drugs
with unknown modes of action such as mi-
noxidil.
Garlic extract has been used as a topical
therapy in the treatment of alopecia areata
(3). Because garlic and onions share many
chemical similarities (4), crude onion juice
has also been tried in the treatment of
alopecia areata.
This study was done to evaluate the effec-
tiveness of topical crude onion juice in the
treatment of patchy alopecia areata.
Patients and Methods
Sixty-two patients with patchy alopecia areata,
who visited the outpatient Department of Der-
matology in Baghdad Teaching Hospital during
the period from April 1999 to April 2000 were
included in this study. Written consent was taken
344 Sharquie and Al-Obaidi

Table 1. Results after four weeks of treatment with crude onion juice

Sex No. of patients Non-responders % Responders %

Male 16 4 25 % 12 75 %
Female 7 2 28.6% 5 71 %
Total 23 6 26 % 17 73.9%

Table 2. Results after six weeks of treatment with crude onion juice

Sex No. of patients Non-responders % Responders %

Male 16 1 6.3% 15 93.7%
Female 7 2 28.6% 5 71.4%
Total 23 3 13 % 20 86.9%

Table 3. Results at eight weeks of treatment with crude onion juice

Sex No. of patients Non-responders % Responders %

Male 16 1 6.3% 15 93.7%
Female 7 2 28.6% 5 71.4%
Total 23 3 13 % 20 86.9%

from each patient to enter the study. This study
was made as a single blind, placebo-controlled
clinical study. All patients were thoroughly as-
sessed regarding the clinical picture, associated
diseases, and family history of alopecia areata in
close relatives. All cases were recent; chronic
and severe cases (alopecia universalis, alopecia
totalis and ophiasis) were excluded. Patients
who previously had received other modalities of
treatment were also excluded. The patients were
divided into two groups.
The first group (crude onion juice treated
group) consisted of 45 patients, 30 males
(66.6%) and 15 females (33.4%). Their ages
ranged between 5 and 50 years with a mean of
23 years. The second group (control) consisted
of 17 patients, 10 males (58.8%) and 7 females
(41.2%). Their ages ranged between 3 and 35
years with a mean of 19 years.
Onion selection and preparation
Onions were collected from local markets.
The Australian brown (5) type was used; this is a
dry round onion with a dry brown skin and a
high degree of volatility. The skin was peeled off,
the onion was chopped into small pieces and the
juice only was obtained using an electric
blender. The juice was kept in closed containers
in the refrigerator.
The control group used only tap water. The
two groups were advised to apply the treatment
twice daily to the affected area, and patients
were followed up for a period of two months.
They were regularly assessed for any terminal
coarse hair re-growth and adverse effects.
Statistical analysis of the results was per-
formed using the Chi-square test (2).
Results
Onion juice treated group
During follow-up, 22 patients defaulted
from the study for unknown reasons, while
the remaining 23 patients completed the
follow up for two months. They included 16
males (69.5%) and 7 females (30.5%); their
ages ranged between 5 and 42 years with a
mean of 22.7 years. Family history of alope-
 Onion Juice in Alopecia Areata
Table 4. Results at eight weeks of treatment for control group
Sex No. of patients Non-responders
Male 8 7
Female 7 6
Total 15 13
cia areata in close relatives was positive in 5
patients (21.7%). Ten patients (43.4%) had
a single patch, and 13 patients (56.5%) had
multiple patches. The duration of illness
ranged between 1 and 12 weeks with a mean
of three weeks.
Hair re-growth started after two weeks. At
four weeks, the hair re-growth was seen in
17 patients (73.9%) (Table 1), and, at six
weeks, the hair re-growth was seen in 20 pa-
tients (86.9%) (Table 2). It was higher
among males (93.7%) than females
(71.4%). Full hair re-growth was seen at 8
weeks in 20 patients (86.9%) (Table 3), and
males (93.7%) still responded better than
females (71.4%), P<0.0001.
Tap-water treated-control group
During follow-up, two patients defaulted
from the study for unknown reason. While
the remaining 15 patients completed the
follow up for two months. They included 8
males (53.3%) and 7 females (46.6%).
Their ages ranged between 3 and 35 years
with a mean of 18.3 years. Family history of
alopecia areata in close relatives was positive
in 3 patients (20%). Eleven patients
(73.3%) had a single patch, and 4 patients
(26.6%) had multiple patches. The dura-
tion of illness ranged between 1 and 8 weeks
with a mean duration of 2.7 weeks. A re-
growth was seen 8 weeks in only 2 patients
(13.3%), and there was no difference in re-
sponse between females and males (Table
4).
Based upon the data and a comparison of
the response at 8 weeks, crude onion juice
induced hair re-growth in a statistically sig-
nificant number of patients (86.9%), com-
pared to the tap-water treated group (13%),
p<0.0001.
345
% Responders %
87.5% 1 12.5%
87.5% 1 12.5%
86.6% 2 13.3%
During follow up, no important adverse
effects were noted in the crude-onion treat-
ed group apart from mild erythema in 14
patients (60.8%). However, some of the pa-
tients disliked the unpleasant odor of the
treatment. Fortunately, ten patients contin-
ued the monthly visit for 6 months; here full
hair re-growth was noted with no relapse.
Discussion
Alopecia areata is an unpredictable, usu-
ally patchy, non-scarring hair loss condition
(1), and many therapeutic agents have been
used in its treatment (2), including topical
and systemic steroids, induction of contact
reactions by several types of irritants and
sensitizers, PUVA, and immunotherapies
such as cyclosporine A, inosiplex, and BCG
(6).
Garlic has been used as a topical therapy
for alopecia areata as part of folk medicine
(79), and, since garlic and onions belong
to the same genus Allium (4, 5), we thought
of using onion as a topical therapy for alope-
cia areata. On reviewing the literature, we
found many similarities in the chemical con-
stituents of garlic and onions, mainly Allicin
(4, 5). The results of the present work
showed that onion juice had a highly thera-
peutic effect on alopecia areata (86.9%),
which is comparable to other topical and
systemic therapies such as BCG im-
munotherapy (69%) (6), and topical im-
munotherapy (58%) (10).
The mechanism of action of crude onion
juice in the treatment of alopecia areata is
difficult to explain. Previous reports
(1113) have stated that onion can induce
allergic contact dermatitis in some individu-
als; however, more recent studies (14)
346 Sharquie and Al-Obaidi
showed that onion extract can inhibit skin
allergic reactions, suggesting that onion
juice may induce an immunological reac-
tion, possibly as a mild form of dermatitis
that can stimulate hair re-growth through
antigenic competition (If there were a rela-
tive lack of T-suppressor cells in the lympho-
cytic infiltrate of alopecia areata, the gener-
ation of non-specific T-suppressor cells
might inhibit the ongoing autoimmune
reation) (15).
Another possible mechanism, is that
onions belong to the genus Allium (4, 5),
which is rich in sulphur and phenolic com-
pounds (16), both of which are known skin
irritants. Onion may cause an irritant con-
tact dermatitis.
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