Alopecia is just another word for hair loss. Usually, the cause and affected area determine the type.
Alopecia areata is a type of hair loss that occurs due to an autoimmune disorder, but when it specifically affects the beard region, it is called alopecia barbae.
A patchy beard is the bane of many men’s existence. Adding alopecia barbae to the mix makes the patchiness even more noticeable, especially in men who sport dark hair.
It becomes a cosmetic problem. But that’s not all it is. The presence of alopecia barbae may be an indicator of underlying health or life problems. They also need to be addressed as a part of the treatment.
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).
It 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.
It should be noted that alopecia areata is a common condition and affects 1 in 50 people in their lifetime, according to UpToDate.
In more severe cases, this condition can result in the loss of the entire body hair (alopecia universalis).
Usually, it is the scalp where hair loss takes place, but according to a 2020 case report in Cureus, 28% of men, the beard region is affected (along the jawline, chin, and cheeks).
Alopecia areata doesn’t always spread from the scalp to the beard. Hair loss may begin in the beard region and then spread to the scalp later on (usually within a year).
More commonly, alopecia barbae occurs in people aged 35, but really anyone can develop it in a matter of days to weeks.
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.
The onset of alopecia barbae can be sudden; it’s not predictable. Eventually, beard hair loss can extend to the scalp.
And it’s possible for alopecia barbae to coexist with alopecia totalis (complete baldness of the scalp) and alopecia universalis.
While the distinctly demarcated coin-shaped patches are the hallmark of alopecia areata, in some patients, alopecia barbae causes diffuse hair loss; it causes an overall thinning in the absence of defined patches.
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 Autoimmune Disease
You are at an increased risk of having alopecia barbae if you already suffer from another autoimmune condition, such as:
- Lupus
- Type 1 diabetes
- Psoriasis
- Vitiligo
- Eczema (atopic dermatitis)
- Rheumatoid arthritis
- Celiac disease
- Pernicious anaemia
- Crohn’s disease
- Asthma
Thyroid disorder can also increase the risk of this type of hair loss. And keep in mind that this condition also causes thyroid hair loss.
Immune system dysfunction can damage healthy hair follicles. In this case, the beard hair may be lost as a result of another autoimmune condition.
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). You may experience alopecia barbae as a result of it. And keep in mind that stress hair loss can also occur due to telogen effluvium, trichotillomania and/or hormonal imbalance.
How To Know If You Have Alopecia Barbae?
Patchy hair loss is not the only symptom of alopecia barbae. Some people experience mild itching and pain before they lose their hair. Inflammation can make bald skin irritated, rough, and red. You might even feel pain.
Other than that, the hair around the edges of the circular patch/patches may become white or lighter in colour.
The patch itself will look smooth with no visible hair follicle opening. But some people have short vellus hair (peach fuzz).
The shaft of the hair may be thinner at the bottom and thicker at the top (like an exclamation mark)
Additionally, there may be black, yellow or white dots on your skin.
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 don’t 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
One study published in Cureus found that platelet-rich plasma (PRP) therapy could successfully treat alopecia barbae. The participants in the study were given 3 injections at 6 weeks intervals.
After the first injection of PRP, alopecia barbae was stabilised. The second injection prompted some hair growth. However, 1 year later, the density was almost entirely restored.
There are growth factors and proteins in PRP which can help speed up wound healing and promote hair growth. PRP is quite popularly used for treating different types of hair loss.
Minoxidil
Minoxidil is a vasodilator that can help the hair in the beard area to grow by increasing the blood flow.
It will supply more oxygen and nutrients to the hair follicles, which can have a positive impact on their growth rate. It’s applied topically on the skin.
Diphencyprone
Diphencyprone is a drug that works by tricking the immune system. It does so by causing allergic contact dermatitis when administered.
This way, instead of attacking the hair follicles, the white blood cells go to the surface of the skin, which allows them to regrow.
This medication is used in the treatment of alopecia areata and can work for alopecia barbae as well.
Anthralin
Used in the treatment of psoriasis, anthralin is a topical drug that can also be used in the treatment of alopecia barbae. This also induces nonallergic dermatitis, which, in turn, allows the hair to regrow.
JAK Inhibitors
Janus kinase inhibitor, also known as JAK inhibitor, is a drug that works by blocking the action of certain enzymes.
As a result, the inflammation caused by the immune system is reduced.
These drugs are used in the management of symptoms of rheumatoid arthritis (an autoimmune disease) but can also help with alopecia barbae.
Laser Therapy
Some studies show that laser therapy can help in the regrowth of hair lost to alopecia areata.
A publication in Dermatologic Surgery showed that a 308-nm excimer laser could effectively grow hair on the scalp and beard.
It can be worth considering this option but do not use any laser devices without consulting your doctor; it is possible that they won’t work.
How To Reverse Alopecia Barbae?
Alopecia barbae usually goes into remission 6-12 months after the onset.
It is not possible to predict exactly how long it will take for your hair to grow back, but full recovery is possible.
But it can take as long as a year for your hair to grow back. Some people decide to get scalp micropigmentation in the meanwhile to camouflage the bald spots, but it’s probably a good idea to wait till the end of a year.
Still, you should know that it’s possible for your beard hair to fall out again as a result of alopecia barbae.
The regrowing hair may also have a different texture and colour. This is something that you should be prepared for.
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.
Since alopecia barbae is autoimmune, it can be difficult to predict the success rate of the surgery. It is possible for you to lose your transplanted hair as a result of this condition.
That’s why make sure to discuss all the pros and cons of the procedure before you decide on it.
Conclusion
A patchy beard can be distressing, but when it’s combined with autoimmune hair loss, it can be worse.
Some people opt for a close, clean shave to get rid of the patchy look, but it’s always better to address the actual cause of the problem.
While it’s not exactly understood, some evidence suggests that autoimmune conditions, genetics or stress may be at play.
Beard hair can be successfully restored using a variety of treatment options, but it’s always best to consult a doctor first.
