Objective To explore the efffcacy and safety of carbon dioxide laser therapeutic apparatus combined with 5% minoxidil in the treatment of patients with alopecia areata. Methods A total of 100 patients with alopecia areata admitted to our hospital from January 2024 to December 2025 were selected, and they were divided into the control group and the study group by the random number table method, with 50 patients in each group. The control group was treated with 5% minoxidil, and the study group was treated with carbon dioxide laser therapy combined with 5% minoxidil. The treatment effect, adverse reactions, hair loss severity and hair status were compared between the two groups. Results The total effective rate of treatment in the study group (94.00%) was higher than that in the control group (76.00%) (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the study group (12.00%) and the control group (8.00%) (P>0.05). The severity of hair loss in the study group was lower than that in the control group, and the number of terminal hairs and follicle density under dermoscopy were higher than those in the control group (P<0.05). Conclusion Carbon dioxide laser combined with 5% minoxidil has deffnite therapeutic effect on patients with alopecia areata. It can effectively relieve alopecia, increase the quantity and density of terminal hairs, and does not increase the risk of adverse reactions. It is worthy of clinical application.