Men suffering from alopecia barbae can lose their whole beard and with it their virility. This is how to start regaining it
If you're reading an article on alopecia barbae, there's a good chance that you or someone you know is suffering from the condition, but know next to nothing about it. Natural Way To Increase Testosterone
As men, we have a certain degree of knowledge about the hair on our bodies. We all know that we usually grow hair on our legs, arms and chest. We also know that around puberty we get pubes and beards, and we also, unfortunately, know that a lot of us, around 6.5 million of us men in the UK, are hurtling towards a future where the hair on top of our head disappears altogether.
But some fact about body hair are less well known. Like, hands up if you knew that hair would appear on your gooch, also known as the perineum, or your back, or that our moustaches would eventually start inside our noses rather than underneath them? But if you didn’t know these things as a boy, it doesn’t take long for most men to be confronted with the difficult-to-shave truths.
There is one fact about body hair that even into adulthood many men remain ignorant of though, so we’ll ask you:
The condition that causes men to lose some or all of their beard is called alopecia barbae. You may already be familiar with alopecia areata, which is when bald spots appear on people's scalps. You may also have heard of alopecia totalis, which is when someone loses all the hair on their head, and alopecia universalis – the complete loss of hair on the scalp and body – but unless you’ve got it, no one really knows that alopecia barbae exists.
‘I'd never heard of or come across anyone who'd lost their beard in isolation,’ says 38-year-old freelance photographer Paul Johnson. ‘I first noticed a five pence circle on the neck line, which I didn't really think anything of at first, until it spread to palm size. I'm now left with just my moustache and a few patches of hair on the jaw line.’
Like Johnson, 43-year-old Ryan Strand’s first experience of alopecia barbae came when a five-pence shaped piece of his beard disappeared. After a few weeks, he explains, he noticed the patch get visibly larger and became concerned enough to seek medical advice.
‘The patch grew and grew to the point that I lost pretty much the entire left-hand side of my beard,’ says Strand. ‘As I'm dark haired, I couldn't even get away with cutting it down to stubble, so I ended up having to shave my beard close, twice a day, otherwise it just looked embarrassing.’
Alopecia barbae is thought to be an auto-immune condition where your body attacks its own hairs, believing them to be foreign. Nobody knows what causes it, but historically there's been a presumed association with both psychological and physical stress, which is what both Johnson and Strand believe was behind their outbreak.
‘The stress on my body was great,’ says Johnson. ‘It wouldn't be out of the norm for me to run 10 miles on a Saturday morning then sink six to seven pints in the afternoon, sleep poorly, train half-hearted on a Sunday and then be back full on from Monday to Friday.’
Johnson explains that the mental stresses that most of us feel, things like worrying over work or what the future has in store, also contributed to his alopecia. ‘I believe that the dent on the mental side of my health has shown itself in the form of alopecia. It's no coincidence whatsoever,’ says Johnson.
A poor diet, smoking and not taking good care of yourself certainly won’t help the problem. While not the cause of alopecia itself, smoking can exacerbate things. For example, toxins found in smoke can damage hair follicles and damage hormones which will impact hair growth. Equally, a healthy lifestyle is not the cure for alopecia, so whether you’re healthy and lead an active lifestyle, or you’re lazy with a poor diet, it doesn’t alter the onset of alopecia.
Onset of alopecia barbae can be sudden and without warning, so the main 'symptom' of the condition on the presence of a gaping hole in your moustache or beard.
However, prior to you losing your hair your may experience itchy skin or some pain in the about-to-be affected area. Once your hair disappears, it's usually the case that the visible skin is smooth, although it can also feel rough, while some people will experience redness, irritation and inflammation in the bald patches.
If you notice yourself losing some or all of your beard then a doctor or dermatologist will be able to diagnose alopecia barbae. Sometimes this can be as simple as looking at your hair loss and making a diagnosis from that.
Alternatively, you may be sent for a scalp biopsy or a blood test to test for signs of an infection or underlying medical condition, including an autoimmune disorder. Your doctor may also want to test you for other conditions that cause hair loss, like fungal infections or thyroid disorders.
As well as not knowing what causes alopecia barbae, we also don’t know how long it takes for beard hair to grow back and the treatments for it aren’t all that effective. Thanks, medicine.
Still, for specialist advice, alopecia barbae sufferers can consult a dermatologist, and preferably one who specialises in hair loss. They won’t have a magic cure, but as consultant dermatologist at The Dermatology Clinic Dr Daniel Glass explains, they will be better placed than a GP to give you an honest assessment about whether your hair is likely to grow back.
‘If a patient had one patch of alopecia in the beard area then there is a good chance that it will regrow spontaneously over time without treatment,’ says Glass. ‘However, if it is more widespread, there will be less chance of it growing back spontaneously and it may require treatment. Sometimes, to encourage the hair to grow back more rapidly, I would recommend either a steroid cream or injection, or other drugs which can alter the inflammation around the hair follicles which cause alopecia areata.’
Although steroids are more commonly associated with juice head gym bros, they’re useful in treating auto-immune diseases because steroids modulate the immune system, so they can dampen down immune activity. They’re by no means guaranteed to work, and for some people, especially men who work out and exercise regularly, it can be difficult to break the long-built negative associations with steroids. Johnson, for example, says that he has been offered steroid injections, but ‘pumping steroids into my beard and head just doesn't seem that logical to me.’
For men not keen on ‘pumping steroids’ into their face, there are new treatments emerging that look promising, but, according to Dr Greg Williams, hair transplant surgeon at the Farjo Hair Institute, ‘Some of them at the moment have quite high side-effect profiles and toxicities, so they're not mainstream.’
Micro-pigmentation tattooing is also an option for patients looking to immediately replace lost stubble, and as Williams explains, it’s an alternative that costs hundreds rather than thousands of pounds and can be done in a way that lets you try it to see what it looks like first.
‘It's different from artistic tattooing, this is medical tattooing. It's called semi-permanent tattooing because the depth that you put the pigment in will determine how long it's going to stay,’ says Williams. ‘You can put it where it disappears in a couple of weeks or months or [you can put it] deeper, where it lasts for a couple of years or deeper still where it's permanent.’
Glass says that he would advise patients to wait for at least a year before exploring permanent options. They should also try to reduce the factors that are thought to exacerbate alopecia barbae, the primary one being stress, before getting a permanent face tattoo. Strand did just that, and it worked for him.
‘My beard started growing back around a year after my first patch appeared. I mentioned that I felt stress was a major factor in my alopecia, and to give you a bit of background, I had some severe financial issues after going through a break-up. I ended up with no alternative but to go bankrupt, and amazingly my beard started growing back almost immediately after doing so,’ he says.
‘It was as if my body had breathed a huge sigh of relief.’
In all honesty, time is the best treatment for alopecia barbae, but certain treatments can help with the body’s recovery. Topical immunomodulators, minoxidil, intralesional steroid therapy, UV therapy, thickening shampoos and, like we mentioned previously, steroids can help regrow and thicken hair. The problem is that in some cases it does nothing and often the person doesn’t need anything but time to get over it.
For someone who has already dealt with alopecia, the fear that it will return can be a very real one. Unfortunately, even if a patient's hair grows back after alopecia, it can be common to have one or more occurrences of the condition.
‘For people with alopecia areata a cure is never possible, and while years may go by without any hair loss, there is always a chance the condition can return,’says the Belgravia Centre.
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