Background 50 Despite high utilization of complementary and alternative medicine (CAM) for alopecia areata 51 (AA), efficacy and safety remain unclear. 52 53 Objective 54 To identify all CAM therapies studied for treatment of AA. Outcomes of interest included 55 disease course and psychological well-being. 56 57 Methods 58 PubMed and Embase were searched to identify English articles containing original data 59 investigating CAM in human subjects with AA from 1950-2018. Quality was assessed with 60 Oxford Centre for Evidence Based Medicine criteria. 61 62 Results 63 Of 1,015 initial citations, 16 articles met inclusion criteria: 5 randomized controlled trials, 5 64 prospective controlled cohorts, 4 prospective non-controlled cohorts, 1 retrospective cohort, and 65 1 case series. CAM therapies with best evidence and efficacy for hair growth in AA include 66 essential oil aromatherapy, topical garlic, and oral glucosides of peony with compound 67 glycyrrhizin. Hypnosis and mindfulness psychotherapy represent low quality evidence for 68 4 improvement of psychological and quality of life outcomes. Adverse events were rare and mild 69 for all therapies evaluated. 70 71 Limitations 72 Inconsistent or poorly reported study methodology and non-standardized outcomes limit the 73 conclusions that can be made from these studies. 74 75 Conclusions 76 This work serves to inform physician management of patients with AA seeking CAM, while 77 encouraging further investigation into these therapies to address some of the therapeutic 78 challenges of AA.