Alopecia Barbae

What Is Alopecia Barbae?

Alopecia barbae is a specific form of alopecia areata—hair loss caused by an autoimmune condition—that affects the beard area, leading to patchy hair loss on the face.

Like alopecia areata, alopecia barbae (aka beard alopecia) is an autoimmune disease in which the body's immune system mistakenly attacks hair follicles, causing sudden, well-defined bald patches in facial hair.

While it’s not physically harmful, having alopecia barbae can feel distressing and sometimes affect self-confidence. The severity and duration of alopecia barbae vary. Some men experience spontaneous regrowth of hair while others experience recurrent or persistent hair loss.

Symptoms of Alopecia Barbae

Beard alopecia typically presents as sudden, uneven hair loss in the beard area, often without warning. Its severity and progression vary from person to person. Some men experience an isolated bald spot in their beard hair (often around the size of a quarter) while others develop more extensive bear hair loss.

Below are the most common symptoms:

• Patchy facial hair loss. The most recognizable symptom of alopecia barbae is the appearance of small, round bald patches within the beard. They often appear suddenly and might expand over time, merging together into larger bald areas on the face.

• Changes in how hair grows back. When hair starts to regrow, it might appear lighter in color than you’re used to, like white or gray, before potentially returning to your natural shade. This is because newly grown hair initially lacks melanin, the pigment responsible for our hair color. Some guys notice uneven regrowth, with some areas taking longer to fill in than others. Others may notice that hairs around the bald patches remain white.

• Progression of hair loss. While some men experience only one or two patches in their beard, others may notice hair loss spreading. The appearance of alopecia barbae can be unpredictable. Although less common, sometimes bald patches can extend to other areas beyond the beard, such as the eyebrows or the scalp, as part of generalized alopecia areata, usually within 12 months.

• Possible inflammation. Unlike many other skin conditions that cause hair loss, like dermatitis or fungal infections, alopecia barbae doesn’t always involve the classic signs of inflammation like redness, swelling, itching, or discomfort in the skin. The skin underneath bald patches is typically smooth without signs of irritation, yet some guys might notice itchiness right before hair loss occurs.

• Unpredictable recurrence. For some guys, beard hair regrowth happens naturally without treatment, but others experience cycles of hair loss and regrowth. Alopecia barbae has no clear pattern of resolution or recurrence, making it unpredictable.

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Causes of Alopecia Barbae

There’s no known definitive cause of alopecia barbae. However, it’s classified as an autoimmune disorder, and these typically stem from a combination of genetic factors, environmental triggers, and lifestyle habits. Researchers believe that several factors may contribute to the development of alopecia barbae, including:

A Misdirected Autoimmune Response

As an autoimmune condition, alopecia barbae occurs when the immune system attacks healthy hair follicles in the facial area, mistakenly treating them as foreign invaders. This causes hair to fall out in distinct patches.

A Genetic Predisposition

There is strong evidence that genetics play a role in alopecia areata. That said, a genetic link is less clear for alopecia barbae specifically. Still, autoimmune conditions are more common in guys who have autoimmune disease in their family history.

You might be at a higher risk of developing alopecia barbae if you have relatives with alopecia areata, rheumatoid arthritis, type 1 diabetes, lupus, or other autoimmune disorders. However, having a genetic predisposition isn’t a guarantee that you’re going to develop it, as other factors influence its onset.

Environmental Triggers

When we’re genetically predisposed to autoimmune conditions, certain external factors can trigger or worsen alopecia barbae. For instance, viral infections, exposure to toxins, seasonal changes, and other stressors to the body can affect immune function in a way that may trigger an autoimmune response.

Stress and Mental Health Factors

We all experience stress in life, but chronic stress and associated low-grade inflammation is often linked to immune system imbalances that may contribute to the onset or progression of alopecia barbae.

Emotional and physical stress doesn’t directly cause alopecia barbae but can act as a trigger in guys who are already genetically susceptible to autoimmune conditions. Some men report experiencing beard hair loss following major life events, illness, or psychological distress.

Hormones

While the link is not yet fully understood, hormonal fluctuations may play a role in alopecia barbae. Some experts think perhaps testosterone and dihydrotestosterone (DHT) levels influence the health of hair follicles, though more research is needed.

Having underlying hormonal (endocrine) disorders, such as thyroid dysfunction, could potentially contribute to or worsen hair loss.

Alopecia barbae likely results from multiple factors. Understanding potential contributors and risks can be helpful for getting an appropriate diagnosis and managing your symptoms.

Risk Factors for Alopecia Barbae

While any guy can develop alopecia barbae, there are certain risk factors related to immune function, genetics, lifestyle, and overall well-being that likely put you at a higher risk than others, such as:

• Autoimmune conditions run in your family. The presence of other autoimmune disorders in close relatives suggests a possible inherited immune system sensitivity. Men with a family history of alopecia areata, vitiligo, rheumatoid arthritis, type 1 diabetes, or other autoimmune diseases may have a higher risk of alopecia barbae. While genetic predisposition plays a significant role in autoimmune conditions like alopecia areata, that doesn’t mean everyone in a family will develop one.

• You have other autoimmune conditions. If you already have an autoimmune condition, such as thyroid disease, lupus, or Celiac disease, you’re more likely to develop alopecia barbae—because your immune system is already prone to mistakenly attacking healthy tissues.

• You’re dealing with the effects of chronic stress or trauma. While it’s not a direct cause of alopecia barbae, psychological or physical stress can trigger or worsen alopecia barbae. This is because stress (especially when ongoing) can weaken the immune system and create imbalances that may contribute to autoimmune activity.

• You’ve had a significant illness or infection. Certain viral illnesses or bacterial infections may act as immune system triggers in men who are predisposed to alopecia barbae. Illnesses that promote systemic inflammation or an overactive immune system can sometimes precede hair loss. While not a universal cause, some men report beard hair loss following fevers, flu-like symptoms, or infections.

• You’re experiencing hormonal abnormalities. Research is limited, but some experts think fluctuations in testosterone and DHT could be involved in certain types of alopecia. For instance, when there are imbalances in thyroid hormones—like with hyperthyroidism or hypothyroidism—this can disrupt normal hair follicle growth and function. If you’re noticing patchy beard hair loss alongside unintentional weight changes, fatigue, or other unusual-for-you symptoms, it may make sense to check in with an endocrinologist.

Diagnosing Alopecia Barbae

Hair loss can be alarming, especially when you notice a sudden onset and can’t pinpoint a cause. Getting an accurate diagnosis requires having a clinical evaluation by a healthcare professional, as several skin- and hair-related conditions can cause similar symptoms.

Here are some common steps you can expect when seeking evaluation for alopecia barbae:

1. Discussion of Medical History and Symptoms

Your healthcare provider will start by asking about your personal medical history, family history of autoimmune diseases, and recent major stresses or illnesses. It’s important to share details about when your hair loss began and changes you’ve noticed in its progression, spread, color, or regrowth.

2. Physical Exam

A dermatologist will closely examine the affected areas of your beard, jawline, and surrounding skin. They will check for smooth bald patches, changes in hair texture, or signs of inflammation. Unlike some other forms of hair loss, alopecia barbae typically presents with no redness, scaling, or irritation, which helps distinguish it from infections or dermatological conditions.

3. Hair Pull Test

A simple pull test may be performed, where your clinician will gently tug on hairs near the affected area to assess how easily they come out. If hair sheds effortlessly or falls out in clumps, this might indicate an active autoimmune attack on your hair follicles.

4. Dermoscopy (Trichoscopy)

To get a closer look at your hair follicles, a dermatoscope (a handheld magnification tool) may be used. This can help identify signs of "exclamation mark hairs," which are short, broken hairs that are narrower at the base, or yellow dots, which are common in alopecia areata-related hair loss. Performing a trichoscopy can also help differentiate alopecia barbae from fungal infections or other dermatologic conditions that could present in similar ways.

5. Skin Biopsy (if Necessary)

If your provider is uncertain after the physical exam, they might order a skin biopsy to be taken from the affected area and analyzed in a lab. This involves removing a tiny sample of skin and hair follicles to check for immune cell activity around the follicles, which is characteristic of alopecia barbae. A biopsy is usually rare in this situation and only needed if the diagnosis is unclear or if another condition, such as scarring alopecia or fungal infection, needs to be ruled out.

6. Blood Tests

Because autoimmune disorders and hormonal imbalances can play a role in alopecia barbae, your healthcare provider may order blood tests to check for thyroid disease, vitamin deficiencies, or other immune-related conditions. If they have concerns about underlying health issues, your doctor may test for specific thyroid hormone levels, iron levels, and inflammatory markers to help confirm a diagnosis.

Once you have a definitive diagnosis, your provider will help you determine the appropriate treatment plan for your alopecia barbae.

Treating Alopecia Barbae

There’s no definitive cure for how to fix bald spots on your beard from this condition. However, alopecia barbae treatment options are available to help manage symptoms and stimulate hair regrowth. Some guys might even experience spontaneous hair regrowth without any interventions.

Some of the most common approaches for alopecia barbae include topical treatments, medical injections, and lifestyle interventions.

Topical Treatments

• Topical corticosteroids. Prescription-strength corticosteroid creams or ointments may be recommended by your healthcare provider to help reduce inflammation and suppress immune activity on your hair follicles. These are generally applied directly to the affected areas of hair loss and it’s important to practice consistency and patience and follow directions for use.

• Minoxidil. The generic name for Rogaine®, topical minoxidil is an FDA-approved hair loss treatment that can also be used for alopecia barbae. This medication works by stimulating blood flow to hair follicles and may help dormant (resting) follicles return to the growth phase.

• Immunotherapy. In cases of extensive or recurrent alopecia barbae, a dermatology professional might prescribe topical immunotherapy medication, such as diphencyprone (DPCP). This is designed to trigger an immune response that distracts your immune system from attacking hair follicles. DPCP is usually reserved for people who don’t respond to standard treatments.

• Janus kinase (JAK) inhibitors. JAK inhibitors (like tofacitinib or ruxolitinib) are newer medications that target the immune pathways involved in alopecia areata. Oral JAK inhibitors have been shown to be effective in severe cases of alopecia areata and topical versions have shown beneficial results in clinical trials. In fact, oral and topical JAK inhibitors have been able to promote up to 75 percent beard regrowth within 12 months.

• Anthralin. This is a topical cream or ointment that helps promote hair regrowth over several months by slowing down the growth of skin cells and reducing inflammation. It’s often used to treat psoriasis but might be prescribed in some cases of alopecia areata.

Injections

• Corticosteroid injections. If you’re dealing with more stubborn patches of hair loss, your provider might recommend steroid injections to help stimulate regrowth every 4 to 6 weeks or so.

• Platelet-rich plasma (PRP) therapy. While PRP therapy is more commonly used for scalp alopecia, some dermatologists offer it for beard hair loss as well. It involves injecting a concentrated solution of your own platelets (red blood cells involved in blood clotting) into affected areas. PRP is thought to promote follicle regeneration and hair regrowth, though results vary, and multiple sessions are usually required.

Lifestyle Changes and Stress Management

While lifestyle changes alone may not reverse hair loss, they can help improve resilience against recurrences—and support your well-being.

It’s impossible to avoid every source of stress in life, but it’s important to have effective tools to respond to stress and help reduce its negative effects on your body. Because stress can trigger or worsen autoimmune conditions, incorporating stress-reducing practices like exercise, meditation, or therapy may help.

Additionally, good nutrition is foundational for every aspect of your health. Eating a balanced diet rich in vitamins, minerals, antioxidants, omega-3 fatty acids, and fiber can support immune function and overall hair health. Read more in our guide to foods for hair growth.

Finally, some people also experiment with natural remedies—though these are likely to be more effective when used alongside other interventions. For example, one small study found a combination of garlic gel with a corticosteroid cream was effective in treating alopecia areata.

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Alopecia Barbae Prevention Tips

While autoimmune diseases like alopecia barbae can’t always be prevented, there are things you can do to help minimize your risk and help keep flare-ups at bay.

• Practice stress management. Stress will always come and go, but you can help minimize its adverse effects on your health and immune response by regularly meditating, doing yoga, journaling, listening to calming music, spending time in nature, and staying physically active.

• Support your immunity. Your immune system is always at work. You can bolster it by eating a nutrient-dense diet, engaging in moderate exercise, practicing good hand hygiene, and getting enough sleep (7 to 9 hours per night is recommended for most adults).

• Nourish your gut. Evidence suggests that having a healthy gut microbiome may help protect against autoimmune disease and flare-ups. Some of the best ways to support a healthy gut include eating plenty of fiber (found in plant foods), managing your stress, and getting probiotics from fermented foods like kefir, sauerkraut, tempeh, and miso.

• Get regular wellness check-ups. Even if you’re not feeling sick, preventive health checks can help identify potential problems early before they get worse (like hair loss in your beard). Regular blood work can help your provider track changes in certain health markers over time and help determine if something needs to be investigated further.

• Avoid harsh beard care. If you’re an aggressive shaver, overly groom your facial hair, or use harsh products, this can irritate hair follicles and contribute to more noticeable shedding. Instead, opt for gentler beard-specific shampoos and conditioners, and moisturize with natural oils like jojoba or argan oil after cleansing.