Objective To investigate PDCA nursing on symptoms and trichoscopy indexes of alopecia patients treated with scalp microneedle. Methods A total of 82 alopecia patients treated with scalp microneedle admitted to our hospital from March 2023 to March 2024 were selected as the research subjects, and they were divided into control group and observation group by the random number table method, with 41 patients in each group. The control group was given conventional nursing, and the observation group was given PDCA nursing. The subjective symptom scores, trichoscopy indexes, psychological state scores, nursing satisfaction and adverse reactions were compared between the two groups. Results After nursing, the scores of alopecia, desquamation, pruritus and greasiness in the observation group were lower than those in the control group (P <0.05). After nursing, the hair average diameter, hair growth density and coarse hair number in the observation group were higher than those in the control group, and the proportion of vellus hair was lower than that in the control group (P <0.05). After nursing, the scores of SAS and SDS in the observation group were lower than those in the control group (P <0.05). The nursing satisfaction in the observation group was higher than that in the control group (P <0.05). The incidence of adverse reactions in the observation group was 2.44%, which was lower than 12.20% in the control group (P <0.05). Conclusion The application of PDCA nursing in alopecia patients treated with scalp microneedle can effectively improve the clinical symptoms, enhance the intervention effect, improve the negative emotions of patients, increase the nursing satisfaction, and reduce the incidence of adverse reactions.