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Alopecia Barbae: Causes, Diagnosis & Treatment
Dr Ahmad Moussa (FRCS)
Medically reviewed by
Dr Ahmad Moussa (FRCS)
Updated on October 26, 2022

Want to know what’s causing those small round bald patches in your beard? You may have alopecia barbae.

Alopecia barbae is a type of hair loss that affects the jaw, face, and neckline. It often occurs in conjunction with alopecia areata — a similar hair loss condition that affects the scalp. Alopecia areata impacts around 300,000 people in the UK [1].

Beard hair loss can be worrying — but no matter what’s causing it, there are plenty of treatments available.

In this article, you’ll learn:

  • What causes alopecia barbae
  • The symptoms of alopecia barbae
  • How clinicians diagnose alopecia barbae
  • The most effective treatments for alopecia barbae

What is alopecia barbae?

Alopecia barbae is an autoimmune condition that causes small circular patches of hair loss in the beard. It’s a type of alopecia areata that specifically affects the beard area, including your neck, jaw and cheeks. Alopecia barbae is sometimes known as beard alopecia areata.

man with alopecia barbae man with alopecia barbae 2

Two men showing symptoms of alopecia barbae [14, 21]

Like scalp alopecia areata, severe or extensive cases of alopecia barbae can eventually lead to alopecia totalis (total loss of facial hair) and/or alopecia universalis (total loss of body hair).

If you’ve always found it difficult to grow a full beard, it’s unlikely that you have alopecia barbae. Some men naturally have sparse or patchy beard growth. This type of hair loss isn’t caused by an autoimmune condition, and can often be treated with topical solutions or beard transplant surgery.

What causes alopecia barbae?

Alopecia barbae is an autoimmune condition. That means it’s caused by your white blood cells attacking your hair follicles.

This autoimmune response may be triggered by the collapse of immune privilege in your beard hair follicles [2]. The exact mechanism that causes immune privilege collapse in hair follicles hasn’t been fully established, but some researchers suggest it’s down to a lack or failure of regulatory T-cells (a type of white blood cell responsible for fighting disease) [3].

Who can get alopecia barbae?

Most beard alopecia areata patients are middle-aged men [3]. Studies suggest that 20% to 42% of alopecia areata patients have a family history of the condition [4]. The risk of developing alopecia barbae is also higher if you have relatives with other autoimmune conditions, such as [3, 5]:

  • Type 1 diabetes — learn more about the link between diabetes and hair loss
  • Vitiligo
  • Thyroid disorders
  • Lupus
  • Psoriasis.

Atopy, alcohol abuse, and smoking may also be risk factors for developing beard alopecia, though more research is needed to establish this [6]. Find out more about hair loss and alcohol consumption.

Many people who have alopecia barbae go on to develop alopecia areata in other areas of their body, such as the scalp. You might see a bald spot on your crown or elsewhere on the head. In one study, this affected almost half of patients [7].

While it’s not always possible to prevent the condition from spreading, it’s important to get the right professional support to manage your beard alopecia.

The impact of alopecia barbae

Fortunately, beard alopecia areata won’t have a significant impact on your physical health. But like most types of sustained or extensive hair loss (including androgenetic alopecia) it has been associated with mental health issues, including depression, anxiety, and neurosis [8]. Learn more about anxiety-related hair loss and depression-related hair loss.

Also, it’s important to investigate the link with other autoimmune conditions. Conditions like type 1 diabetes and lupus can have a significant impact on your wellbeing, so if you have alopecia barbae, your doctor may perform additional tests to see if you have any other underlying conditions.

Symptoms of alopecia barbae

The most obvious symptoms of alopecia barbae are smooth round bald patches in your beard, where there was previously hair growth. These patches are visible on the neck, jawline, or cheek. Without treatment, these may develop into larger patches which eventually join up, creating more uneven shapes.

Alopecia barbae is a type of non-scarring hair loss, which means the follicles and skin aren’t usually inflamed or itchy [3]. Learn more about scarring alopecia.

You may also see hair loss with similar symptoms elsewhere on the body, such as the scalp, eyebrows, eyelashes, moustache, arms and legs [6]. Learn more about the causes of eyebrow hair loss.

These symptoms are relatively unique compared with other types of beard hair loss, so they can be easy to spot. However, they do share similarities with certain hair loss conditions like trichotillomania and telogen effluvium. That’s why it’s important to get a professional diagnosis of your condition before you start any treatments.

Diagnosing alopecia barbae

An experienced trichologist can diagnose your beard hair loss by looking at your skin and hairs under a microscope. They’ll look for telltale signs of alopecia barbae, such as [3, 6, 9]:

  • Exclamation mark hairs — small broken hairs that taper downwards towards the follicle
  • Short vellus hairs — fluffy grey-white hairs, especially around the bald patch
  • Yellow, white, or black dots on the skin — these are hairs that have fragmented or broken before emerging from the skin.

exclamation mark hairs examplevellus hairs example yellow spots on skin alopecia areata

1. Exclamation mark hairs. 2. Vellus hairs. 3. Yellow dots on the skin.

Some studies have identified other less common signs of alopecia barbae. These include tulip-shaped hairs, and bruising and brown marks around the follicles (known as perifollicular haemorrhage and peripilar signs) [6].

But these indicators are also seen in other types of hair loss (such as male pattern baldness or female pattern hair loss) so they don’t necessarily indicate alopecia barbae or alopecia areata.

Unlike alopecia areata, alopecia barbae doesn’t usually cause changes in your fingernails (like discolouration or splitting) [3].

Treating alopecia barbae

You may have heard that shaving your facial hair can make it grow back thicker — but this is unfortunately a myth.

While beard hair loss can be stressful and make you feel self-conscious, alopecia barbae actually has a high rate of spontaneous remission [10]. That means the hair may grow back by itself without treatment. This is more likely if you have mild hair loss that doesn’t worsen or spread to other parts of the body, or if you developed the condition after puberty.

If your beard hair regrows by itself, you can expect to see full regrowth within 6 to 12 months [10-11].

Not everyone recovers quickly from alopecia barbae, so there are also many ways to treat beard alopecia areata.

Corticosteroids

Topical corticosteroids are often the first port of call for treating alopecia barbae. They reduce inflammation and suppress the immune reaction that causes your white blood cells to attack your hair follicles.

If topical corticosteroids are ineffective, they can also be injected into the affected areas [5].

Minoxidil

Minoxidil is a popular hair restoration solution that’s suitable for treating a range of hair loss conditions.

Studies into the use of Minoxidil for general beard growth have had mixed results [11-12]. But some research suggests that it can boost hair growth for alopecia areata patients when used in conjunction with other treatments like corticosteroids [13]. See real patient photos of before and after Minoxidil beard growth results.

Platelet-rich plasma (PRP) therapy

PRP therapy involves taking a sample of your blood, then extracting and concentrating your platelets. The clinician then reinjects your platelets at the hair loss site, stimulating hair growth.

PRP therapy can work well for patients with alopecia barbae [14]. While more research may confirm suitability for a broader range of patients, this is a promising treatment for those with prolonged episodes of alopecia barbae.

Diphencyprone

There’s limited research into the use of diphencyprone for treating beard alopecia areata specifically. But it has promising results for treating scalp alopecia areata — and since there are many similarities between the conditions, treatments may also work well for those with alopecia barbae [15].

This topical treatment is one of the best ways to promote regrowth in those with alopecia areata. In one study, almost two-thirds of patients who had experienced the condition for up to 10 years had a good or excellent response to diphencyprone [16].

JAK inhibitors

Following successful clinical trials, the US Food and Drug Administration recently approved the first JAK inhibitor, Olumiant, for treating alopecia areata [17-18]. While Olumiant hasn’t been trialled for alopecia barbae patients yet, its effectiveness on alopecia areata patients makes it promising for those with beard alopecia.

JAK inhibitors work by blocking JAK enzymes that send immune response signals within the body. This minimises the body’s immune response, preventing the immune system from attacking your hair follicles.

Anthralin

More commonly used as a treatment for psoriasis, anthralin is sometimes prescribed to patients with severe alopecia areata [19]. Anthralin is a topical treatment that you’ll need to apply to the affected area for up to several hours.

One study has shown anthralin to be particularly effective for treating alopecia areata if used in conjunction with calcipotriene, another psoriasis treatment [20]. Calcipotriene is a vitamin D derivative. While vitamins for hair growth are usually ineffective, research suggests this topical derivative may stimulate regrowth in patients with alopecia areata. Future research may establish the impact on alopecia barbae specifically.

Can I have a beard transplant to treat alopecia barbae?

Because alopecia barbae is a type of alopecia areata, beard transplants aren’t an effective way to treat this condition. Autoimmune conditions will continue to affect you even after a transplant. That’s why it’s not usually suitable as a treatment for beard alopecia areata. Learn more about hair transplants for alopecia areata patients.

Beard transplants are growing in popularity, thanks to their effectiveness in treating other types of beard hair loss or lack of growth. A hair transplant clinic can help you diagnose your condition and determine whether you’re a good candidate for a beard transplant.

Find out the best age to have a beard transplant.

What to do if you think you have alopecia barbae

If you’ve noticed any kind of patchiness or hair loss across your face or beard, it’s time to seek a diagnosis. Alopecia barbae can indicate other underlying health problems, so it’s critical to get your hair loss checked out.

Book a free consultation at the Wimpole Clinic on Harley Street. Our experienced surgical team will diagnose the cause of your beard hair loss and help you find the right treatment to tackle it.

Alopecia Barbae: Causes, Diagnosis & Treatment, Wimpole Clinic

Sources:

  1. The epidemiology of AA: a population-based cohort study in UK primary care
  2. Lymphocytes, neuropeptides, and genes involved in AA
  3. Alopecia Areata of the Beard: A Review of the Literature
  4. Diagnosing and Treating Hair Loss
  5. Incipient Diabetes Mellitus and Nascent Thyroid Disease Presenting as Beard Alopecia Areata: Case Report and Treatment Review of Alopecia Areata of the Beard
  6. Clinico-Dermoscopic Pattern of Beard Alopecia Areata: A Cross-Sectional Study
  7. Beard alopecia areata: A multicentre review of 55 patients
  8. Psychiatric comorbidities in patients with alopecia areata in Taiwan: a case–control study
  9. Dermoscopy in Hair Disorders
  10. Common Hair Loss Disorders
  11. Bald Patch in the Beard
  12. Minoxidil and its use in hair disorders: a review
  13. Systemic steroids with or without 2% topical minoxidil in the treatment of alopecia areata
  14. Successful Treatment of Alopecia Areata Barbae with Platelet-rich Plasma
  15. Efficacy of diphenylcyclopropenone in alopecia areata: a comparison of two treatment regimens
  16. The efficacy of topical diphencyprone in the treatment of alopecia areata
  17. A Study of Baricitinib (LY3009104) in Participants With Severe or Very Severe Alopecia Areata (BRAVE-AA1)
  18. A Study of Baricitinib (LY3009104) in Adults With Severe or Very Severe Alopecia Areata (BRAVE-AA2)
  19. Evaluation of anthralin in the treatment of alopecia areata
  20. Case report of novel combination of anthralin and calcipotriene leading to trichologic response in alopecia areata
  21. Treatment of alopecia areata with topical garlic extract
Dr Ahmad Moussa (FRCS)
Medically reviewed by Dr Ahmad Moussa (FRCS)Updated on October 26, 2022
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
Talk to a specialist ☎ 020 7935 1861.
Dr Ahmad Moussa (FRCS)
Medically reviewed by
Dr Ahmad Moussa (FRCS)
Updated on October 26, 2022

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