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SUMMARY
Hair loss in the beard may be reversible or irreversible, and appropriate effective treatments are available depending on the condition. Overall, clinical studies specifically focused on beard alopecia are limited.
Physiologic beard distribution is commonly patchy, especially up to the third decade of life, due to hair follicle heterogeneity. Topical minoxidil can enhance hair growth.
Alopecia areata of the beard presents classically as smooth bald patches with characteristic trichoscopy findings. Various immunosuppressive and immunomodulatory therapies have demonstrated efficacy for beard hair regrowth.
Frontal fibrosing alopecia and lichen planopilaris involve irreversible destruction and scarring of hair follicles with permanent loss of the beard.
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TIPS FOR TREATMENT
Topical treatment options are effective for alopecia areata of the beard, including topical minoxidil, topical prostaglandin agonist, topical immunotherapy, and topical JAK inhibitors.
Topical and intralesional corticosteroids can cause atrophy in this region and should be used with caution.
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DON’T FORGET
Uneven distribution of beard hair can be physiologic, particularly in young age.
Incomplete growth of the beard is a contraindication to treatment with oral finasteride/dutasteride.
Beard has an important role in certain cultures or religions.
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PATIENT EDUCATION POINTS
Causes for alopecia of the beard region include physiologic beard distribution, alopecia areata, frontal fibrosing alopecia, and mycosis fungoides which may be categorized based on reversible or irreversible etiologies.
Clinical examination including trichoscopy is often sufficient.
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SUMMARY FOR THE CLINICIAN BOX
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Beard hair plays an important role aesthetically and in certain cultures or religions. Loss of beard hair can cause severe psychosocial impairment. There are several causes for alopecia of the beard region, including physiologic incomplete beard distribution, alopecia areata, frontal fibrosing alopecia, and mycosis fungoides. It is important to differentiate between reversible and permanent etiologies and provide appropriate management to prevent further progression and damage.
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The human beard has been a longstanding symbol of manhood and virility. In the context of natural selection, Charles Darwin in The Descent of Man (1871) categorized this secondary sexual characteristic as an evolutionary benefit with the power to attract potential mates.1 The significance and popularity of the beard has fluctuated since then, but growing a beard nevertheless remains a key part of the male identity. An incomplete beard can cause significant distress, especially within cultures or religions that place special importance on a full beard of hair.2–4 There are ...