Background: Alopecia areata (AA) is a common autoimmune condition characterized by localized hair loss, often impacting patients’ quality of life. Effective treatment options include intralesional triamcinolone and the 308 nm Excimer laser, each with unique mechanisms and potential benefits. However, comparative studies on their efficacy for localized AA remain limited. Objective: To compare the efficacy, patient satisfaction, and relapse rates between intralesional triamcinolone and 308 nm Excimer laser in the treatment of localized AA. Methods: Fifty-five patients with localized AA were randomly assigned to two treatment groups: intralesional triamcinolone (n=27) administered every 4 weeks or 308 nm Excimer laser therapy (n=28) applied weekly for 12 sessions. Hair regrowth was evaluated using a 4-point scale at 4, 8, and 12 weeks, with secondary outcomes including patient satisfaction, side effects, and relapse rates at a 6-month follow-up. Results: The intralesional triamcinolone group demonstrated significantly higher hair regrowth scores at 12 weeks (mean 2.8 vs. 2.3, p < 0.01) and reported higher satisfaction (mean score 4.3 vs. 3.7, p = 0.03). Relapse rates were lower in the triamcinolone group (18.5%) compared to the Excimer laser group (32.1%). Both treatments were generally well-tolerated with mild, manageable side effects. Conclusion: Intralesional triamcinolone appears to be more effective than the 308 nm Excimer laser for localized AA, providing faster regrowth and greater patient satisfaction with fewer relapses. Treatment choice should consider patient preferences for invasiveness, urgency, and potential side effects.