Alopecia areata (AA) is an autoimmune disorder characterized by well-demarcated patches of hair loss with preservation of the hair follicle (HF). It generally is a nonscarring alopecia that can be extensive and refractory to treatment. We propose modification to an already widely used first-line treatment by diluting intralesional triamcinolone acetonide (ILTA) to 2.5 mg/mL in 1% lidocaine and epinephrine 1:100,000 in place of normal saline (NS). Our 2 cases of severe AA are among many in our practice that responded with seemingly permanent hair regrowth using this novel combination regimen. We hypothesize that local vasoconstriction due to epinephrine potentiates the ILTA and that epinephrine also may play an independent role.