Alopecia areata is an autoimmune disease that results in hair loss. In cases where it is specific to the beard region, it is known as alopecia barbae.
In general, people dislike patchy beards, but alopecia barbae can leave noticeable bald patches, which can be a cosmetic concern. This guide will help you understand what alopecia barbae is, its causes, and treatments.
What Is Alopecia Barbae?
Alopecia barbae refers to the localised loss of hair in the beard. This condition is also referred to as alopecia areata of the beard (BAA) or alopecia areata barbae (AAB). The age at which BAA usually begins is 31 years old.
Alopecia barbae is a form of alopecia areata in which the body’s own immune system starts attacking normal, healthy cells. In this case, white cells infiltrate the hair follicles and cause inflammation.
Though alopecia areata occurs most commonly on the scalp in men, the beard is the second most commonly affected area, according to one study.
Forouzan P, Cohen PR. Incipient Diabetes Mellitus and Nascent Thyroid Disease Presenting as Beard Alopecia Areata: Case Report and Treatment Review of Alopecia Areata of the Beard. Cureus. 2020 Jul 31;12(7):e9500. doi: 10.7759/cureus.9500. PMID: 32766019; PMCID: PMC7398044/Creative Commons
Alopecia barbae can also coexist with alopecia totalis (complete baldness of the scalp) and alopecia universalis (complete loss of hair on the scalp and body).
Can Alopecia Barbae Spread To The Scalp?
Alopecia areata doesn’t always spread from the scalp to the beard. However, hair loss may begin in the beard region and then spread to the scalp.
How Does Alopecia Barbae Look Like?
If you have alopecia barbae, you may notice the presence of a small circular or oval-shaped patch in your beard.
There may be one or more patches spread throughout the beard. Over time, those small patches may grow in size, including large swathes of your beard area.
What Causes Alopecia Barbae?
The exact cause of alopecia barbae is not known, but it’s believed to occur due to one or more of the following reasons:
Pre-Existing Health Conditions
You may be at an increased risk of having alopecia barbae if you already suffer from another autoimmune condition, such as lupus, type 1 diabetes or psoriasis.
Reportedly, atopic dermatitis (eczema) is also a risk factor for the development of alopecia areata and alopecia universalis. Therefore, it can affect your beard area as well.
Family History
In some cases, family history may be responsible for the development of alopecia barbae. For instance, if someone in your family has had the same experience, it can be indicative of a genetic basis for this type of hair loss. Your genetic makeup can put you at a greater risk for alopecia barbae.
Stress
Stress can trigger your immune system to attack your own hair follicles. This stress can be physical (illness, injury) or psychological (job, life changes), and you may experience alopecia barbae as a result of it.
What Are The Signs You Have Alopecia Barbae?
Patchy hair loss is not the only symptom of alopecia barbae, as people may also experience pain and itchiness. You may also feel a tingling sensation before the hair falls out.
Other than that, the hair around the edges of the circular patch/patches may become white or lighter in colour. The patch itself will have a smooth appearance, although “yellow dots, broken hair, and short vellus hairs” may be seen in dermoscopic findings of alopecia barbae, as reported in one literature review.
How Is Alopecia Barbae Diagnosed?
For the diagnosis of alopecia barbae, you may need to see a trichologist or a dermatologist.
They’ll begin by performing a physical examination to check the skin of the scalp and the pattern of hair loss.
A blood test may also be required to rule out other health conditions. It is also possible that they do a scalp biopsy. In this, a small piece of skin will be removed from your scalp and closely examined in a lab.
How To Treat Alopecia Barbae?
There are different treatment options for alopecia barbae, but they might not always work. The success rate of the treatment can vary between patients.
However, this doesn’t mean that you shouldn’t seek treatment at all. It is possible that it works and stops the patch from growing larger in size.
Keep in mind that there is no cure for alopecia barbae itself, but its symptoms have been managed through medications.
Your doctor will prescribe it depending on the size of the affected area, your age, along with the severity and duration of the disease.
Steroids
Steroids are most commonly prescribed for alopecia barbae. They work by suppressing the immune system and lowering its activity. As well as being applied topically, it can also be injected.
Platelet-Rich Plasma Therapy
Platelet-rich plasma (PRP) injections can also be used in the treatment of alopecia barbae. PRP contains growth factors and proteins that can speed up wound healing and promote hair growth.
According to a case study published in Cureus in 2020, a 30-year-old man with alopecia areata barbae received three injections of PRP at six-week intervals, resulting in a successful outcome. The first injection resulted in the stabilisation of the condition, while the second prompted some initial hair growth. At the 1-year follow, “robust regrowth” was reported.
Pototschnig H, Madl MT. Successful Treatment of Alopecia Areata Barbae with Platelet-rich Plasma. Cureus. 2020 Apr 1;12(4):e7495. doi: 10.7759/cureus.7495. PMID: 32368427; PMCID: PMC7193229/Creative Commons
Minoxidil
Minoxidil is a vasodilator that may promote hair growth in the beard area by increasing blood flow. This will increase oxygen and nutrient supply to the hair follicles, which can, in turn, have a positive effect on their growth rate.
Diphencyprone
Diphencyprone is a sensitising agent that works by inducing allergic contact dermatitis on administration. Instead of attacking the hair follicles, this drug makes the white cells go to the surface of the skin, allowing them to regrow.
This medicine has been used in the treatment of alopecia areata and may be considered for alopecia barbae as well by your doctor.
Anthralin
Anthralin is another drug that is used in the treatment of alopecia areata. It’s believed that the anti-inflammatory effect of the drug and its ability to induce “irritant contact dermatitis” can help in the regrowth of hair.
A combination of anthralin and diphenylcyclopropenone has been reported to successfully regrow beard hair in patients with extensive alopecia areata.
JAK Inhibitors
Janus kinase inhibitors or JAK inhibitors are “disease-modifying anti-rheumatic drugs” (DMARDs) which work by suppressing the immune system.
Three JAK inhibitors — baricitinib, deuruxolitinib and ritlecitinib — have been approved by the FDA, but they’re for the treatment of severe alopecia areata.
There are others, however, that have also been used in the treatment of alopecia areata of the beard. For instance, in a study published in 2020, oral tofacitinib, a JAK inhibitor, was used to effectively regrow hair in patients with beard alopecia areata.
Laser Therapy
The use of laser therapy may be helpful in regrowing beard hair lost to alopecia areata barbae. A 308-nm excimer laser has been used successfully in the treatment of alopecia areata of not just the scalp but the beard as well in one study.
How To Reverse Alopecia Barbae?
Alopecia barbae usually goes into remission 6-12 months after the onset. Though there is no cure for alopecia barbae, the condition can be managed with different treatments — some of them have even been reported to show full regrowth.
Still, keep in mind that a relapse can occur, and your hair can fall out again as a result of this condition.
Can You Get A Beard Transplant With Alopecia Barbae?
If you have alopecia barbae, you can get a beard transplant, but it’s only possible when the disease is in remission.
A case study describes a successful surgery in an alopecia barbae patient using follicular unit transplantation; the patient grew his hair in 6 months, and no relapse was noted in the 1-year follow-up.
Even so, since alopecia barbae is autoimmune, it can be difficult to predict the success rate of the surgery. That’s why make sure to discuss all the pros and cons of the procedure before you decide on it.
Experiencing Beard Hair Loss?
Longevita can you put you in touch with independent clinicians within our network, for both surgical and non-surgical treatment options for different types of alopecia. If you’re interested in learning more do not hesitate to get in touch!
Frequently Asked Questions
Spontaneous remission can occur in alopecia areata of the beard. Therefore, the condition can go away on its own, however, it can also make a comeback.
Alopecia barbae is not considered a dangerous condition, but if you have certain health conditions, you may be at risk of developing alopecia areata of the beard — which is why you must consult a medical professional.
Generally, hair loss due to alopecia barbae is not permanent. Different treatments can help you regrow your hair. Aside from that, this condition can also go into spontaneous remission, and your hair can start to regrow.
Unfortunately, there is no cure for alopecia barbae, but it can be managed with different treatments, such as steroids, minoxidil, contact sensitisers, PRP, JAK inhibitors and laser.
Dr Cagla
Dr Cagla earned her medical degree at Trakya University’s Faculty of Medicine in Bulgaria and has almost 6 years of hair transplantation experience. She is a specialist in FUE, DHI and Sapphire hair transplants of the scalp, eyebrows and beard and has performed over 6,000 surgeries. Dr Cagla is multilingual, with fluency in English, Bulgarian and Turkish.
