Alopecia Barbae: Causes, Symptoms, and Treatments
Alopecia barbae is a type of autoimmune disorder that affects facial hair, often causing patchy hair loss on the beard, cheeks, jawline, and neck. This condition is a specific form of alopecia areata, which affects hair follicles throughout the body. While alopecia areata can cause scalp hair loss, alopecia barbae exclusively impacts the facial hair of men, leading to small circular patches of hair loss. These patches can vary in size, from the diameter of a 10p coin to as large as a 50p piece, and in some cases, the hair loss can progress to complete baldness in the beard area, known as alopecia totalis.
Although it can be alarming for sufferers, alopecia barbae is generally temporary, with facial hair often regrowing within months. However, repeated episodes are common, especially during times of stress or immune system imbalances. In this article, we’ll delve deeper into the causes, symptoms, and various treatment options available for managing this condition.
What Causes Alopecia Barbae?
Alopecia barbae, like other forms of alopecia, is caused by an autoimmune response. In this case, the body’s immune system mistakenly attacks the hair follicles in the beard area. Normally, our immune systems are designed to protect us from harmful pathogens. However, in autoimmune disorders like alopecia, the immune system malfunctions, targeting the body's own tissues—in this case, the hair follicles.
The exact cause behind the collapse of immune privilege in hair follicles is not yet fully understood. Immune privilege refers to the body’s ability to protect certain areas, like hair follicles, from immune system attacks. Some scientists speculate that a failure or deficiency in regulatory T-cells, which are responsible for controlling immune responses, could be at the heart of this issue. This immune dysregulation results in the immune system attacking its own hair follicles, leading to hair loss.
In addition to genetic predispositions, other factors such as stress, hormonal imbalances, and other autoimmune disorders may also play a role in triggering alopecia barbae. People with conditions such as vitiligo, thyroid disorders, or type 1 diabetes are thought to have a higher risk of developing alopecia barbae. Although there’s no definitive answer as to why some people develop this condition while others don’t, it’s clear that the immune system’s role is central.
Recognising the Symptoms of Alopecia Barbae
The hallmark symptom of alopecia barbae is the sudden appearance of smooth, bald patches in the beard area. Unlike other forms of hair loss that progress gradually, such as male pattern baldness, alopecia barbae appears relatively quickly. The patches are usually round or oval, with no visible signs of inflammation or irritation in the surrounding skin.
In severe cases, these patches can expand, joining together to create larger, irregularly shaped areas of hair loss. While alopecia barbae primarily affects the beard, it’s not uncommon for sufferers to experience similar hair loss elsewhere on their body, such as the scalp, eyebrows, eyelashes, or even arms and legs.
Some tell-tale signs of alopecia barbae that might be observed by medical professionals under microscopic examination include:
Exclamation mark hairs – Short, broken hairs that taper towards the follicle.
Vellus hairs – Fine, soft, unpigmented hairs that can regrow around bald patches.
Dots on the skin – These could be yellow, white, or black, indicating hairs that have broken before emerging from the skin.
It’s important to consult a dermatologist or trichologist for an accurate diagnosis. Although alopecia barbae shares some similarities with other hair loss conditions, such as trichotillomania (compulsive hair pulling) or telogen effluvium (stress-induced shedding), a professional diagnosis will help confirm the condition and guide treatment options.
The Psychological Impact of Alopecia Barbae
Hair loss, especially when it affects the face, can have significant psychological effects. A beard is a key feature for many men, often linked to their identity, masculinity, and self-esteem. The sudden and visible nature of alopecia barbae can lead to feelings of embarrassment or self-consciousness. Some sufferers may even experience anxiety or depression as a result of their appearance.
It’s crucial to address the mental health challenges that often accompany alopecia barbae. Support from healthcare professionals, including therapists, can be helpful in managing the emotional toll. Moreover, joining support groups or talking to others who have experienced similar conditions can also provide comfort and a sense of community.
Treatment Options for Alopecia Barbae
While alopecia barbae is usually temporary and may resolve on its own, some patients seek treatments to accelerate hair regrowth or manage the condition during flare-ups. There’s no one-size-fits-all approach, but several options have shown effectiveness in clinical practice:
Topical Corticosteroids
Corticosteroids are often the first line of treatment for autoimmune-related hair loss. They work by reducing inflammation and suppressing the immune response around the hair follicles. Topical corticosteroids can be applied directly to the affected areas, and in some cases, steroid injections may be administered for a more targeted approach.
Minoxidil
Widely used for scalp hair loss, minoxidil is a topical solution that can also be applied to the beard area. It works by increasing blood flow to the hair follicles, stimulating regrowth. Although its efficacy for beard-specific alopecia is still under investigation, some patients have reported positive results, especially when used alongside corticosteroids.
Micro-Needling
Micro-needling involves using a small roller covered in fine needles to create tiny punctures in the skin. This technique helps improve blood circulation and encourages the skin’s natural healing processes, potentially stimulating hair regrowth. When combined with minoxidil, micro-needling may further boost the efficacy of the treatment.
Platelet-Rich Plasma (PRP) Therapy
PRP therapy has gained popularity as a non-invasive option for various types of hair loss, including alopecia barbae. During this treatment, a sample of the patient’s blood is taken, and the platelets are concentrated and reinjected into the affected areas. Platelets contain growth factors that may encourage hair regrowth and help repair damaged follicles.
Diphencyprone (DPCP)
DPCP is an immunotherapy treatment that is sometimes used to stimulate hair regrowth in cases of alopecia areata, including alopecia barbae. This topical treatment sensitises the skin to an allergic reaction, which may help "distract" the immune system from attacking hair follicles. While its use in beard-specific alopecia is less common, research has shown promising results in treating scalp alopecia areata.
JAK Inhibitors
JAK inhibitors are a newer class of drugs that target immune system pathways involved in autoimmune diseases. One such drug, Olumiant (baricitinib), has been approved for treating alopecia areata. These inhibitors work by blocking specific enzymes known as Janus kinases (JAKs), which are responsible for triggering inflammatory responses. Ritlecitinib, another JAK inhibitor currently being studied, has shown promise in clinical trials for its ability to treat autoimmune-related hair loss. While these treatments are primarily aimed at scalp alopecia, their mechanism of action holds potential for alopecia barbae sufferers as well.
7. Anthralin
A topical medication often used to treat psoriasis, anthralin is also sometimes prescribed for alopecia areata. It works by irritating the skin, which may stimulate hair regrowth. Studies have suggested that combining anthralin with calcipotriene, a vitamin D derivative, can improve results in patients with alopecia areata.
Why Beard Transplants Aren’t Suitable for Alopecia Barbae
Unlike other types of hair loss, such as male pattern baldness, alopecia barbae isn’t a permanent condition. Hair transplants are typically not recommended for treating autoimmune-related hair loss because the immune system may continue attacking the transplanted follicles, rendering the procedure ineffective. Moreover, because alopecia barbae often resolves on its own, surgery is considered unnecessary and not a viable long-term solution.
Conclusion
Alopecia barbae can be an unsettling experience, particularly due to the sudden and visible nature of the hair loss. However, it’s essential to remember that this condition is usually temporary, with hair regrowth occurring in most cases within a few months. While there’s no definitive cure, there are several treatment options that can help manage the condition, ranging from topical solutions like corticosteroids and minoxidil to newer therapies like PRP and JAK inhibitors, including ritlecitinib.
The key to coping with alopecia barbae is patience and, in some cases, medical intervention. If you’re experiencing symptoms, it’s essential to seek a proper diagnosis and explore treatment options that best suit your needs. With the right approach, you can manage the condition effectively and regain both your hair and confidence.
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