Patchy beard and bald spots in the beard

What it is

There are two different situations. Many men have a beard that has always grown unevenly, thinner on the cheeks or with gaps: this is decided by genes and hormones, and often fills in slowly through the twenties and early thirties. Others notice a new, smooth, completely bald patch, often round or oval, in a beard that used to be full. This is often alopecia areata, a condition in which the immune system temporarily stops hair follicles from growing hair.

How it works

In alopecia areata the follicles are not destroyed, so hair can grow back. Patches can last for months, and short broken hairs ("exclamation mark" hairs) are sometimes seen at the edge of a patch that is spreading. In people with just a few small patches, hair often regrows within a year without treatment, though new patches can appear later. Other causes of patches include fungal infection, deep follicle infection with scarring, and scarring from repeated razor bumps.

Why it matters on darker skin

Alopecia areata affects people of all skin colours. On darker skin, a fungal infection or scarring can sometimes look similar to it, and dark marks from old bumps can make a beard look patchier than it is. Correct diagnosis matters because the treatments are completely different.

Causes and triggers

Genes and age for a naturally patchy beard. For alopecia areata, the cause is an immune reaction; it is more common in people with a family history of it or with thyroid disease, eczema or vitiligo, and stress may play a part. Infection and scarring cause patches that are scaly, inflamed or shiny.

What helps — and why it works

For a naturally patchy beard: give it time, keep it evenly trimmed with clean clippers so the patchy areas look intentional, and choose a beard shape that suits how your hair grows. For a new bald patch: see a doctor to confirm what it is. Alopecia areata in the beard is often left to regrow on its own, and a doctor may offer treatments such as steroid injections into the patch or other options; strong steroid creams are generally avoided on the face. Minoxidil is sometimes used, but only on a doctor's advice, because it often irritates facial skin.

What to avoid and why

Avoid "beard growth" oils, serums and supplements that promise a full beard: oils soften hair but do not create new follicles, and most growth products are untested. Avoid steroid creams bought without advice on a bald patch, which can thin facial skin, and avoid picking or scratching patches.

Common mistakes

• Assuming a new bald patch is just a patchy beard.
• Spending money on growth products.
• Shaving the whole beard repeatedly in the belief that it will grow back thicker; it does not.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.