Losing hair can be distressing, especially when it affects the eyebrows. Eyebrows play a crucial role in protecting the eyes from sweat and debris, as well as in expressing emotions. Thinning eyebrows, or eyebrow hypotrichosis (eyebrow madarosis), can be caused by a variety of factors, ranging from normal aging processes to underlying medical conditions. Madarosis is the medical term for the loss of eyebrows or eyelashes. Madarosis of the eyebrows is called superciliary madarosis, while madarosis of the eyelashes is called ciliary madarosis.
As people age, it's common to experience hair thinning or loss on the scalp, eyebrows, eyelashes, and other areas. Over time, some hair follicles cease to produce hair, and existing hair shafts become finer. Hair also loses its color, turning white or gray. This type of hair loss is a natural part of aging.
Imbalances in thyroid hormones can lead to eyebrow hair loss. This is often associated with:
In hypothyroidism, hair loss may be particularly noticeable in the outer third of the eyebrow, the thinnest part that points toward the ears, also known as Hertoghe's sign or Queen Anne's sign. Other symptoms of thyroid disorders can include dry or moist skin, a swelling in the neck (goiter), coarse and brittle hair, a dry and itchy scalp, and thick, brittle nails. Thyroid-related hair loss is usually temporary, and hair typically returns to its normal fullness once thyroid levels are balanced with medication.
Autoimmune conditions occur when the immune system mistakenly attacks the body's own cells. In some cases, the immune system may target hair follicles, leading to hair thinning, patchy hair loss, or complete hair loss. Autoimmune conditions that can cause hair loss include:
Read also: Scarring Alopecia: An Overview
Alopecia Areata (AA): This condition causes patchy hair loss on the scalp and other areas of the body, including the eyebrows and eyelashes. Trichoscopic features of AA of eyebrows and eyelashes are often subtle. Exclamation point hairs are not very numerous, but cadaverized hairs and yellow dots are usually visible. Severity of the disease can be assessed using the clinician-reported outcome (ClinRO) and the patient-reported outcome (PRO) for eyebrow and eyelash loss. ClinRO and PRO are based on a scale rating from 0 (no involvement) to 3 (complete loss). Other newly developed scales include the Brigham Eyebrow Tool for Alopecia (BETA) and Brigham Eyelash Tool for Alopecia (BELA). The BETA utilizes eyebrow landmarks, surface area of involvement, and hair density to calculate an eyebrow score, while the BELA utilizes eyelash count, distribution, and prominence of hairs of the upper lashes to establish its score.
Frontal Fibrosing Alopecia (FFA): This form of alopecia primarily affects postmenopausal women. Eyebrow loss often occurs before scalp hair loss, affecting the lateral eyebrow first. Eyebrow loss often begins on the lateral eyebrow, with subsequent thinning, partial, or complete loss. The most relevant trichoscopy findings of eyebrow FFA include tapered and broken hairs, multiple pinpoint dots, short thin/vellus hairs, hair growing in different directions, dystrophic hairs, black dots (cadaverized hairs), red dots (follicular openings with increased vasculature), and yellow dots (follicular infundibula with sebum or keratotic material).
Discoid Lupus Erythematosus (DLE): This chronic autoimmune condition causes skin sores, scarring, and hair loss on the face and eyebrows. Discoid lupus erythematosus (DLE) is an autoimmune disorder that can uncommonly present with erythema and scaly plaques on the bilateral or, rarely, unilateral eyelids, with a predilection for the lower and lateral eyelids.
Localized scleroderma: Localized scleroderma is a disorder of excessive collagen deposition that can present as unilateral atrophy of the frontoparietal region above the eyebrow. Known as “en coup de sabre” (French for “the blow of the sword”) for its resemblance to the scar of a sword wound, linear morphea of the paramedian forehead and scalp can be accompanied by eyebrow depression and hair loss
Healthy skin is essential for healthy hair growth, as hair follicles reside within the skin. Certain skin conditions can cause itchy, flaking skin rashes, leading to eyebrow hair loss due to inflammation, dryness, and rubbing or itching the area around the eyebrows. Common skin conditions that can cause eyebrow hair loss include:
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Atopic Dermatitis (Eczema): Eczema causes skin to become dry, scaly, and itchy. When eczema develops above the eyes, it can lead to thinning eyebrows (also known as Hertoghe's sign or Queen Anne's sign). Managing inflammation often allows hair to regrow in the eyebrow area.
Psoriasis: This chronic skin condition can develop on any part of the body, including the eyebrow area. Psoriasis occurs when the body produces skin cells at an abnormally fast pace, causing the skin to thicken and form plaques. Hair loss can occur in the affected area.
Seborrheic Dermatitis: Seborrheic dermatitis can cause itchy, flaking skin rashes, potentially leading to eyebrow hair loss.
Lichen planopilaris: A rare condition, lichen planopilaris causes the skin and mucus membranes to become inflamed. When inflammation occurs, it can cause scarring that may lead to hair loss on the scalp or eyebrows.
Adequate nutrition is crucial for maintaining healthy skin and hair. Deficiencies in certain nutrients can contribute to eyebrow hair loss. These include:
Read also: Diagnosing Leg Hair Thinning
Fatty Acid Deficiency: A lack of fatty acids, found in fish, nuts, and seeds, may cause eyebrow hair loss.
Biotin Deficiency: Insufficient biotin intake can result in thinning hair and loss of body hair.
Zinc Deficiency: A lack of zinc can lead to hair loss. Zinc supplements may aid hair regrowth in individuals with a deficiency.
Certain medications can list hair loss as a potential side effect, affecting the eyebrows as well. These medications may include:
Acitretin: A retinoid drug used to treat skin conditions like psoriasis.
Chemotherapy: A cancer treatment that often causes hair loss throughout the body.
Valproic Acid: An anticonvulsant drug used to treat seizures and bipolar disorder.
Endocrine therapy: Endocrine therapy-induced hair loss, due to usage of medications such as selective estrogen receptor modulators and aromatase inhibitors, can also present with alopecia of eyebrows and eyelashes.
Chemotherapeutic agents: Chemotherapeutic agents used to treat neoplastic conditions can also contribute to madarosis. In particular, agents such as taxanes, doxorubicin, and cyclophosphamide have been seen to cause hair loss approximately 1 week to 1 month after initiation.
Although less common, certain genetic conditions can lead to eyebrow hair loss:
Ectodermal Dysplasias: This group of conditions affects the skin, hair, nails, and teeth and can cause sparse or missing hair in the eyebrows, eyelashes, and other body parts.
Netherton Syndrome: This condition affects the skin, hair, and immune system, causing fragile and easily broken hair, or "bamboo hair." This condition is usually present from birth.
Keratosis follicularis spinulosa decalvans (KFSD): Keratosis follicularis spinulosa decalvans (KFSD) is an X-linked disorder of keratinization that causes follicular hyperkeratosis and scarring alopecia of the eyebrows, eyelashes, and scalp. The disease typically begins on the face and presents as sparse eyebrows and eyelashes, but can also ultimately cause ophthalmic abnormalities including blepharitis, conjunctivitis, and photophobia
Infections can also cause eyebrow hair loss.
Ringworm: Ringworm in the eyebrow area is another infectious cause of brow hair loss. More than 40 kinds of fungi can trigger this contagious infection. People with ringworm may also develop itchy skin, a rash in a ring shape and cracked, scaly skin along with eyebrow hair loss.
Lepromatous leprosy: Lepromatous leprosy may interfere with hair growth, leading to eyebrow and eyelash loss early in the disease, preceding the characteristic development of leonine facies.
Cutaneous syphilis: Cutaneous syphilis may also result in patchy alopecia of the scalp, beard, eyebrows, and eyelashes.
Varicella zoster virus (VZV): Varicella zoster virus (VZV) can infect the ophthalmic division of the trigeminal nerve, and reactivation of VZV can cause scarring of the eyelid. A few cases have reported unilateral loss of upper lid eyelashes related to VZV.
Less common reasons for eyebrow hair loss include:
Radiation: Radiation therapy, particularly to the head, can cause hair loss, including eyebrow hair loss.
Amyloidosis: Amyloidosis is a rare disease that occurs when an abnormal protein called amyloid builds up in your organs and interferes with their normal function.
Sarcoidosis: Sarcoidosis is a disease characterized by the growth of tiny collections of inflammatory cells (granulomas) in any part of your body - most commonly the lungs, lymph nodes, eyes and skin.
Chemical Burns: Chemical burns can damage hair follicles, leading to hair loss.
Trichotillomania: This is a hair-pulling disorder where individuals compulsively pull out their hair, including eyebrow hairs. Some people pull hairs out of their eyebrows as a self-calming habit. The scientific term for this is trichotillomania. Individuals with the condition often don't realize that they are doing it, so it can be difficult to identify.
Basal Cell Carcinoma and Squamous Cell Carcinoma: These skin cancers can, in rare cases, affect the eyebrows and cause hair loss.
Folliculotropic Mycosis Fungoides: One such report describes an adult patient who developed eyebrow alopecia in the setting of mycosis fungoides, and histopathology showed a folliculotropic infiltrate of atypical lymphocytes sparing the epidermis.
To determine the cause of eyebrow hair loss, a doctor will typically:
Inquire about symptoms: They will ask about the onset, duration, and characteristics of hair loss, as well as any associated symptoms.
Review medical history: They will gather information about family history of hair loss conditions, diet, and other relevant factors.
Perform a trichoscopy: This involves a close examination of the eyebrow hair to help diagnose conditions like alopecia areata and frontal fibrosing alopecia. The shape of the hairs and the presence of white patches can aid in diagnosis.
Order blood tests: Blood tests may be conducted to check thyroid hormone levels (T3 and T4) to identify any hormonal imbalances.
Treatment for eyebrow hair loss depends on the underlying cause. Some common treatments include:
Topical Bimatoprost 0.03%: This topical treatment, approved for eyelash regrowth, can be applied directly to the eyebrows. Studies suggest promising results with once-daily application. Side effects may include contact dermatitis, skin hyperpigmentation, and itchy skin.
Corticosteroids: Steroid creams or ointments can slow hair loss. Corticosteroid injections can also stimulate hair growth, particularly in cases of alopecia areata.
Minoxidil: Topical minoxidil (5%) may be used in combination with corticosteroids to treat alopecia areata.
Hair Transplant or Microblading: These options do not regrow hair but can provide a fuller appearance to the eyebrows.
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