Alopecia Barbae: What You Need to Know

Quick Summary: Alopecia Barbae: What You Need to Know

• What is Alopecia Barbae: An autoimmune condition causing bald patches in the beard area due to the immune system attacking hair follicles.
• Causes: Linked to family history of autoimmune diseases, high stress levels, and potentially other lifestyle factors.
• Common symptoms: Smooth, round patches of baldness that may expand and potentially lead to hair loss in other areas of the body.
• Diagnosis: A dermatologist evaluates the affected area, often using a microscope to confirm the diagnosis and rule out other conditions.
• Treatment options: Treatments include topical corticosteroids, minoxidil, platelet-rich plasma therapy, JAK inhibitors, and other therapies for severe cases.
• Beard transplants: Beard transplants are generally not recommended for alopecia barbae due to its unpredictable nature, but may be considered if the condition has been stable for several years and a stable donor area is available. If alopecia barbae has not affected the scalp, hair from the scalp can be transplanted into the beard to restore a fuller appearance, provided the donor hair is healthy and unaffected by alopecia.

Hair loss is a common concern that affects individuals in various ways, and one lesser-known form is alopecia barbae (also known as alopecia areata barbae), a condition specifically targeting facial hair, particularly the beard. This autoimmune disorder can cause bald patches in your beard, potentially impacting your confidence and self-esteem. Understanding its causes, symptoms, and treatment options is crucial for effectively managing alopecia barbae.

What is Alopecia Barbae?

Alopecia barbae is a specific type of hair loss that affects the beard area. This condition occurs when the immune system mistakenly attacks the hair follicles, resulting in hair loss​¹. The exact cause behind this autoimmune response is not fully understood, but it is believed to be linked to the collapse of the immune privilege in hair follicles​. In other words, the body perceives its own hair follicles as foreign invaders and attacks them, preventing hair growth. Many men experience alopecia barbae, but because facial hair can be shaved off or styled to cover the patches, it’s not always visible. This can make it seem less common than it actually is.

Causes and Risk Factors for Alopecia Barbae

Alopecia areata, including alopecia barbae, occurs when the body’s immune system mistakenly targets hair follicles, leading to hair loss. This condition disrupts the natural protection of the hair follicle, known as hair follicle immune privilege. When this defence is compromised, it results in inflammation around the base of the follicle and can halt hair growth temporarily. While it’s clear that this immune response causes hair loss, it’s still uncertain whether specific features of beard hair make it more prone to this condition compared to other areas of the body¹.

A family history of autoimmune diseases such as type 1 diabetes, lupus, or thyroid disorders is one of the strongest predictors². Other potential risk factors include high stress levels, alcohol consumption, and smoking, although further research is needed to establish these connections conclusively​³.

Additionally, people with a history of alopecia areata elsewhere on their body may also be prone to alopecia barbae⁴.

Symptoms of Alopecia Barbae

The hallmark symptom of alopecia barbae is smooth, round patches of baldness in the beard area. These patches may expand over time and, without treatment, could merge, leading to more significant hair loss​. These bald patches often appear suddenly and can vary in size. In some cases, individuals may notice the presence of “exclamation mark” hairs—short, broken hairs that are narrower at the base near the follicle, which is a common feature of alopecia areata​¹.

Around 50% of individuals with active alopecia barbae develop additional hair loss beyond the beard within a year. The scalp is typically the next area affected, followed by the limbs and eyebrows. This progression is more likely to occur when alopecia barbae remains active over an extended period, with longer durations of beard hair loss often leading to hair thinning or loss in other parts of the body⁴. Early diagnosis and intervention can help manage the condition and potentially reduce its spread​.

Diagnosing Alopecia Barbae

If you suspect alopecia barbae, it’s best to consult a dermatologist for proper evaluation. A professional can examine the affected area and may use a microscope to analyse the hair follicles, looking for specific signs like broken or thinning hairs. This thorough assessment is essential for confirming the diagnosis and ruling out other conditions. Early detection allows for timely treatment, improving the chances of regrowth and managing the condition effectively. You can book a consultation with us for a thorough evaluation and personalised treatment options​.

Treatment Options for Alopecia Barbae

The good news is that alopecia barbae can sometimes resolve on its own, with hair regrowth occurring within 6 to 12 months. However, this isn’t always the case, and many people seek treatment to speed up the recovery process​. While there is no known cure for alopecia areata and barbae yet, several treatments are available that aim to manage symptoms and encourage hair regrowth. 

• Topical Corticosteroids: These are the first line of treatment for many individuals with alopecia barbae. Corticosteroids help reduce inflammation and suppress the immune response, giving the hair follicles a chance to recover​⁴.
• Minoxidil: Commonly known for treating scalp hair loss, minoxidil may also promote beard hair regrowth. It was originally prescribed to treat high blood pressure. However, results have been mixed, and it is often used in combination with corticosteroids for better outcomes​. Minoxidil comes in three forms: a solution, a foam and an oral tablet. Read more about using minoxidil for beard growth here.
• Platelet-Rich Plasma (PRP) Therapy: This promising treatment involves injecting a concentrated solution of the patient’s own platelets into the affected area. The growth factors in the platelets may stimulate hair regrowth, particularly for patients with prolonged hair loss​⁵.
• JAK Inhibitors: This newer class of medications, including FDA-approved drugs like Olumiant, has shown effectiveness in treating alopecia areata. With regard to Alopecia Barbae specifically, the JAK inhibitor tofacitinib has shown positive results⁶.
• Other Treatments: In more severe cases, treatments like diphencyprone and anthralin—both commonly used for other forms of alopecia—may be prescribed. These treatments help to stimulate the immune response locally, encouraging hair to regrow¹​.
• For tips on managing a patchy beard and promoting thicker facial hair growth, check out this helpful guide here.

Alopecia Barbae and Beard Transplants

Hair transplants are generally not recommended for alopecia barbae due to the condition’s unpredictable nature and potential for spontaneous hair regrowth with other treatments. However, in cases where hair loss has remained stable for several years despite other therapies, a transplant may be considered, provided there is a stable donor area. If alopecia barbae has not spread to the scalp, hair can be extracted from the scalp to be transplanted into the beard. This approach utilises the healthy hair follicles from the donor area on the scalp and strategically places them in the patchy areas of the beard.

It’s crucial that the donor hair is stable and not affected by alopecia, ensuring the transplanted hair will grow successfully in the new location. This procedure can help restore a fuller, more even beard appearance, providing a solution for those struggling with persistent beard hair loss due to alopecia barbae. If you’re considering a hair transplant, it’s essential to consult with experts who can offer honest advice, discuss your options, and set realistic expectations based on your unique situation.

Did You Know? Fascinating Facts about Alopecia Barbae

• It Can Appear Overnight: One of the most surprising aspects of alopecia barbae is its sudden onset. Many men notice a smooth, hairless patch in their beard area seemingly overnight. This rapid progression can be alarming, but the good news is that it doesn’t usually lead to complete hair loss on the face.
• It’s Not Contagious: Some people might wonder if alopecia barbae is contagious, but rest assured, it’s not. You cannot catch it from someone else, as it is solely a result of your immune system’s behavior.
• It Can Affect Eyebrows and Eyelashes Too: While alopecia barbae specifically refers to hair loss in the beard area, some men may also experience similar patchy hair loss in other areas, such as the eyebrows or eyelashes, due to the nature of alopecia areata.

FAQs about Alopecia Barbae

• Q: Can alopecia barbae spread to other parts of the body?

A: Yes, in some cases, alopecia barbae can spread to other parts of the body, resulting in alopecia areata (patchy hair loss on the scalp), alopecia totalis (total scalp hair loss), or alopecia universalis (total body hair loss). However, this is relatively rare.

• Q: Will my beard hair grow back the same as before?  

A: In most cases, hair will regrow in the affected areas, though it might initially be finer or lighter. Over time, it usually returns to its normal texture and color.

• Q: Is there anything I can do to prevent alopecia barbae?

A: While there’s no guaranteed way to prevent alopecia barbae, maintaining a healthy lifestyle and managing stress can help reduce the risk of triggering the condition.

Conclusion

While alopecia barbae can be distressing, particularly for those who take pride in their facial hair, it is a manageable condition with a high chance of hair regrowth. Early diagnosis and treatment can help minimize the extent of hair loss and promote faster recovery. If you notice sudden bald patches in your beard or other symptoms of alopecia, consulting a dermatologist or hair specialist is the first step toward proper diagnosis and treatment. Seeking professional advice ensures you receive personalized care and can explore the best treatment options to restore your beard.

References

1. Nwosu, A. and Miteva, M. (2023) ‘Alopecia areata barbae in a Nutshell’, Skin Appendage Disorders, 9(3), pp. 179–186. Available at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10264905/. 
2. Forouzan, P. and Cohen, P.R. (2020) ‘Incipient diabetes mellitus and nascent thyroid disease presenting as Beard Alopecia Areata: Case report and treatment review of alopecia areata of the beard’, Cureus [Preprint]. Available at:https://www.cureus.com/articles/37491-incipient-diabetes-mellitus-and-nascent-thyroid-disease-presenting-as-beard-alopecia-areata-case-report-and-treatment-review-of-alopecia-areata-of-the-beard#!/. 
3. Girisha, B., Bhandary, D. and Mahadevappa, B. (2019) ‘Clinico-dermoscopic pattern of Beard alopecia areata: A cross-sectional study’, Indian Dermatology Online Journal, 10(6), p. 644. Available at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859745/. 
4. Saceda‐Corralo, D. et al. (2016) ‘Beard alopecia areata: A multicentre review of 55 patients’, Journal of the European Academy of Dermatology and Venereology, 31(1), pp. 187–192. Available at:https://www.researchgate.net/publication/306000894_Beard_alopecia_areata_A_multicentre_review_of_55_patients. 
5. Pototschnig, H. and Madl, M.T. (2020) ‘Successful treatment of alopecia areata barbae with platelet-rich plasma’, Cureus [Preprint]. Available at:https://pubmed.ncbi.nlm.nih.gov/32368427/. 
6. Kerkemeyer, K.L. et al. (2020) ‘Response of alopecia areata of the Beard to oral tofacitinib’, Journal of the American Academy of Dermatology, 82(5), pp. 1228–1230. Available at:https://pubmed.ncbi.nlm.nih.gov/31678329/.