Background: Alopecia areata (AA) is a disease of the hair follicles with multifactorial etiology and a strong component of autoimmune origin. The mechanisms that lead to hair loss in AA are still unclear. An aberrant pattern of cytokine expression of the T-helper Th1cell type has been detected. So far, IFN-gamma, interleukins, TNF-alpha, are cytokines that are well known to play a major role in the pathogenesis of the disease. Objective: To determine the efficacy and safety of using the phototoxic doses of ultraviolet A (UVA) after application of topical 8- methoxypsoralen in the treatment of extensive and resistant cases of AA. Methods: 40 patients fitting the inclusion criteria were randomly allocated into one of two interventional groups: Group A (20 patients): receiving phototoxic doses of UVA after topical application of psoralen (test therapy group).Group B (20 patients): receiving potent intralesional corticosteroids (conventional therapy group).Each group was treated for 3 months and followed up for an additional 3 months. A biopsy was taken at baseline and at the end of treatment (3 months to compare the level of expression of IFN-γ, IGF-1 and TGF-ß1 before and after therapy. Results: At 3 months, No significant difference was found between phototoxic and corticosteroid groups as regards the mean SALT nor the percent change of SALT from baseline (p= 0.808 and 0.204 respectively). Although not statistically significant, the percent change of IFN-γ showed a mean reduction in both groups, with patients receiving phototoxic doses of PUVA showing a tendency towards higher mean reduction {-35.97% ± 18.81, 95% CI: [2.37 to 3.83]} in comparison to patients receiving intralesional corticosteroids {-29.03 ± 17.80, 95% CI: [-37.36 to -20.7]}.At 6 months No significant difference was found between phototoxic and corticosteroid groups as regards the mean SALT nor the percent change of SALT from baseline (p= 0.808 and 0.735 respectively) Treatment success was achieved by 45% of patients in both groups. Conclusion: The current study offers a proof that phototoxic regimen of PUVA exerts an immunomodulatory role and that it deserves to be placed among therapeutic tools used in the treatment of the of AA, owing to both its efficacy and safety.