Eyebrow Hair Loss: Causes, Diagnosis, and Treatments

Eyebrows play a crucial role in facial aesthetics, emotional expression, and protection of the eyes. Experiencing eyebrow hair loss can be distressing, prompting concerns about appearance and potential underlying health issues. This article explores the various causes of eyebrow hair loss, diagnostic approaches, and available treatment options.

Understanding Madarosis

Madarosis is the medical term for the loss of eyebrows or eyelashes. When eyebrow hair loss occurs, it is specifically called superciliary madarosis, while eyelash loss is termed ciliary madarosis. It is important to distinguish madarosis from normal hair shedding, where a few strands are lost daily. Madarosis involves losing hair more rapidly and in larger quantities than usual.

Eyebrows protect the bones above your eyes. They also act like built-in sweatbands and prevent sweat from running down your forehead into your eyes. Your eyelashes act like filters that protect your eyes from dust and other small pieces of debris. They also trigger your eye’s natural reflex to blink or close if they’re disturbed.

All of your hair is part of a growth cycle - new strands grow and take the place of older ones. Madarosis and other types of hair loss happen when you’re losing more than your hair follicles can naturally replace.

Depending on what’s causing madarosis, you’ll probably notice other symptoms in the skin on or near your eyes.

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A healthcare provider or eye care specialist will diagnose and treat the condition that’s causing your eyebrows or eyelashes to fall out. How madarosis is treated depends on what’s causing your eyebrows or eyelashes to fall out.

Visit a healthcare provider or eye care specialist as soon as you notice any hair loss - especially if you’re experiencing other symptoms like pain or skin discoloration.

Types of Madarosis

Madarosis can manifest in two primary forms:

• Superciliary Madarosis: Hair loss specifically affecting the eyebrows.
• Ciliary Madarosis: Hair loss affecting the eyelashes.

Additionally, madarosis can be classified as scarring or non-scarring, depending on the underlying cause and whether it results in scarring of the skin around the hair follicles.

Common Causes of Eyebrow Hair Loss

Eyebrow hair loss, also known as eyebrow hypotrichosis or eyebrow madarosis, can be caused by various factors, ranging from normal aging processes to underlying medical conditions.

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Normal Aging Processes

As people age, hair thinning or loss can occur on the head, eyebrows, eyelashes, and other body areas. Hair follicles may cease producing hair over time, and hair shafts become finer, losing their color and turning white or gray.

Hormonal Imbalances

Imbalances in thyroid hormones can lead to eyebrow hair loss. This is linked to:

• Hyperthyroidism: The body produces too much thyroid hormone.
• Hypothyroidism: The body does not produce enough thyroid hormone. In hypothyroidism, hair loss may occur in the outer third of the eyebrow, the thinnest part pointing towards the ears.

Other symptoms of thyroid disorders include dry, pale skin, a swelling in the neck (goiter), coarse, dry, brittle hair, a dry, itchy scalp, and thick, dry, brittle nails. Thyroid-related hair loss is usually temporary, and hair should return to its usual fullness once thyroid levels return to normal with prescribed medication.

Autoimmune Conditions

Autoimmune conditions occur when the immune system mistakenly attacks its own body cells, including those contributing to hair growth. Autoimmune conditions that can cause hair loss include:

• Alopecia Areata: Causes patchy hair loss on the head and other areas, including the eyebrows.
• Frontal Fibrosing Alopecia: Primarily affects people after menopause; eyebrow hair loss occurs before scalp hair loss in about 39% of cases.
• Discoid Lupus Erythematosus: A chronic autoimmune condition causing skin sores, scarring, and hair loss on the face and eyebrows.

Skin Conditions

Healthy skin is essential for healthy hair growth, as hair grows directly from follicles in the skin. Certain skin conditions can cause itchy, flaking skin rashes, leading to eyebrow hair loss due to inflammation, dry skin, and rubbing or itching. Common skin conditions include:

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• Atopic dermatitis
• Psoriasis
• Seborrheic dermatitis
• Eczema

When your skin becomes inflamed, it can become itchy, red, and irritated, or it can even start oozing. These flare-ups are an uncomfortable product of having eczema and, unfortunately, can interfere with hair follicles embedded in the skin. Eczema is a common skin disease that is long-lasting, and treating it is all about controlling flare-ups.

Nutritional Deficiencies

The food a person eats has a substantial impact on their skin and hair health. The body needs certain nutrients to create healthy hair.

Nutritional deficiencies that can cause eyebrow hair loss:

• Fatty Acid Deficiency: Lack of fatty acids, found in fish, nuts, and seeds, may cause eyebrow hair loss.
• Biotin Deficiency: Insufficient biotin can result in thinning hair and loss of body hair.
• Zinc Deficiency: A lack of zinc can lead to hair loss. Zinc supplements may help with hair regrowth in people with a deficiency.
• Vitamin A, C, E, B-7 (Biotin), B-12, and D
• Iron
• Cysteine
• Omega-3 Fatty Acids

Medication Side Effects

Certain medications can cause hair loss as a potential side effect, affecting the eyebrows. These medications include:

• Acitretin, a retinoid drug for skin conditions like psoriasis
• Chemotherapy, a treatment for cancer
• Valproic acid, an anticonvulsant drug for seizures and bipolar disorder

Genetic Conditions

Less commonly, genetic conditions can lead to eyebrow hair loss. These include:

• Ectodermal Dysplasias: Affect the skin, hair, nails, and teeth and can cause sparse or missing hair in the eyebrows, eyelashes, and other body parts.
• Netherton Syndrome: Affects the skin, hair, and immune system, causing fragile, easily broken hair or "bamboo hair."

Other Causes

Less common reasons for eyebrow hair loss include:

• Radiation
• Amyloidosis
• Sarcoidosis
• Chemical burns
• Trichotillomania, a hair-pulling disorder
• Basal cell carcinoma
• Folliculotropic mycosis fungoides
• Squamous cell carcinomas
• Syphilis
• Hansen’s disease (leprosy)
• Stress and anxiety
• Hormonal imbalances due to pregnancy or childbirth
• Contact dermatitis
• Seborrheic dermatitis
• Tinea capitis (ringworm)
• Eyebrow loss with age
• Over-Plucking or Waxing
• Scars

Diagnostic Approaches

Diagnosing the cause of eyebrow hair loss involves a comprehensive evaluation by a doctor. This may include:

• Medical History: Asking about symptoms, symptom duration, and family history of hair loss conditions, diet, and other relevant factors.
• Trichoscopy: A close examination of the eyebrow hair to diagnose alopecia areata and frontal fibrosing alopecia. The shape of the hairs can help determine whether a person has alopecia. In frontal fibrosing alopecia, there may also be white patches.
• Blood Tests: Testing T3 and T4 thyroid hormone levels to identify hormonal imbalances.

Trichoscopy Findings in Different Types of Alopecia

Trichoscopy is a valuable diagnostic tool for evaluating eyebrow and eyelash alopecia. Here's a summary of trichoscopy findings associated with different conditions:

• Alopecia Areata (AA): Subtle findings, with few exclamation point hairs but visible cadaverized hairs and yellow dots.
• Frontal Fibrosing Alopecia (FFA): Tapered and broken hairs, multiple pinpoint dots, short thin/vellus hairs, hairs 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). Dystrophic hairs, whitish areas with absent follicular openings, and hairs growing in different directions are more specific to eyebrow FFA.
• Lepromatous Leprosy: Reduced hair density, multiple vellus hairs, and distorted pigmentation of skin.
• Tinea Infections: Comma hairs (51%), corkscrew hairs (32%), bent hairs (27%), morse code hairs (22%), and zigzag hairs (22%). Eyelash trichoscopy reveals widespread scale, broken hairs, bent hairs, and morse code hairs.

Treatment Options

Treatment for eyebrow hair loss depends on the underlying cause. Addressing the cause can, in many cases, allow a person to regrow the hair.

• Topical Bimatoprost 0.03%: FDA-approved for eyelash regrowth, bimatoprost is applied directly to the eyelashes. Several studies have found that applying bimatoprost once per day can bring very promising results.
• Corticosteroids: Applying steroid creams or ointments can slow hair loss. Corticosteroid injections can also stimulate hair growth, particularly for alopecia areata.
• Minoxidil: A topical solution applied twice daily, often used with corticosteroids for treating alopecia areata.
• Hair Transplant or Microblading: These options do not enable hair regrowth but can give the eyebrows a fuller appearance. Eyebrow restoration is an excellent way to replace eyebrows or touch up small areas of hair loss. A small amount of hair from your head is transplanted to your eyebrow region. The procedure is performed by a qualified physician and takes only 2-3 hours.
• Medications for Thyroid Imbalances: Doctors can prescribe medication to balance thyroid levels.
• Treatments for Skin Conditions: Managing inflammation often allows hair to regrow in the eyebrow area. Your dermatologist may perform a patch test to assess whether allergies are exacerbating symptoms, or they may prescribe medicine, skin care regimens, and lifestyle change recommendations.
• Nutritional Adjustments: You can adjust your diet to include vitamin-rich foods and vitamin supplements to strike a better balance. Talk to your dermatologist or a nutritionist for recommendations.
• Treatment for Trichotillomania: Treatment for trichotillomania usually involves therapy and counseling to help people with the condition learn new coping skills.

The Significance of Eyebrows and Eyelashes

Eyebrows and eyelashes serve multiple functions:

• Protection: They protect the eyes from sweat, rain, light, dust, microorganisms, and other particulate matter. Eyelashes play a role in the aerodynamic flow of air around the eye and protect the cornea.
• Emotional Expression: Eyebrows are integral to non-verbal communication and the expression of emotions.

Due to the varied functional and emotive purposes of eyebrows and eyelashes, as well as the visibility of the hairs, madarosis has been associated with significant emotional and psychologic distress.

tags: #eyebrow #hair #loss #causes

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