Background: Alopecia areata is a chronic inflammatory disease with unknown etiology resulting in non-scarring hair loss. Till now there is no recommended treatment for alopecia areata. Aim of the study: we aimed to evaluate the efficacy of topical minoxidil versus combination of topical minoxidil with 308‐ nm excimer laser in treating patchy alopecia areata. Patients and methods: A randomized controlled trial was conducted among 60 patients diagnosed with scalp alopecia areata and assigned to two treatment groups: Group A (30 patients) received topical minoxidil 2%, and Group B (30 patients) received topical minoxidil 2% combined with 308-nm excimer laser therapy. Biochemical, histopathological, immunohistochemical study, and dermoscopic imaging were used to evaluate therapeutic response. Results: A significant reduction in all alopecia areata-related dermoscopic findings were observed in both treatment modalities compared to both groups before and after therapy with significant efficacy in group B compared to group A. The microscopic examination of skin sections of Group A after 12 weeks revealed sparse inflammatory lymphocytic infiltration around hair follicle while, in Group B revealed irregular island of basaloid cells representing the telogen germinal unit. Immunohistochemical stained sections showed negative immunoreaction for CD8 T lymphocyte in both treated groups indicating decreased inflammatory lymphocytic infiltration. While, there were increased immunoreaction for PCNA in both treated groups indicating hair cell growth. Erythema and Itching were the insignificant adverse effects of both treatment modalities. Conclusion: the combination of 308-nm excimer laser therapy with topical minoxidil has superior efficacy in achieving hair regrowth compared to topical minoxidil only