Madarosis is a clinical sign that has become pathognomonic of leprosy in countries like India. However, this apparently benign clinical sign has wider ramifications in many systemic and dermatological disorders. Hence, establishing a proper diagnosis and appropriate management is mandatory. Though management of the primary disease results in regrowth of eyebrows and eyelashes, many require surgical management. Thus, the management of a patient with madarosis requires a coordinated effort from the dermatologist, ophthalmologist, internist, and reconstructive surgeon.

If you’ve gotten through this list and still don’t know what’s going on, it’s time to talk to your doc. Unfortunately, madarosis–typically used to mean the loss of eyelashes, but also referring to the loss of brows–may be due to many, many things, including a number of vision and life-threatening conditions, like herpes zoster, leprosy, HIV/AIDS, trachoma, malignant eyelid tumors, discoid lupus, scleroderma, and hypothyroidism (Khong, Casson, Huilgal, Selva; Survey of Opthamology, 2006). Brow and lash loss are both indicators of underlying diseases, so yes get to your doc stat.
It is perfectly normal for people to shed 50 to 100 hairs per day. This generally doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time that hair is shedding. However, hair loss occurs when this hair growth cycle and shedding is disrupted or when the hair follicle becomes destroyed and replaced with scar tissue. Female pattern hair loss (androgenetic alopecia) is the most common form of hair loss in women. This occurs gradually and is caused by genetics (from either side of the family), age, and the action of a specific male hormone, dihydrotestosterone (DHT). This hormone is found in lesser amounts in women and it preys on the hair follicles, preventing them from receiving vital nutrients for proper hair follicle growth, leading to the hairs shrinking, and resulting in a shorter lifespan. Interestingly, DHT does not need to be elevated to generate hair loss. Estrogen, when lowered as commonly seen in menopause, creates a change in the ratio of male to female hormones, giving an edge to these male hormones. Compounded with the sensitivity of DHT to the hair follicles, heredity can affect the age at which a woman begins to lose her hair, as well as the rate of hair loss and the extent of baldness. 
Scurf refers to the scales and greasy crusts that accumulate along the hair shaft and indicates the presence of seborrhea.[26,27] Collarettes are composed of hard fibrinous scales[25,28] surrounding each individual eyelash. They travel upward along with the growth of the lashes and are indicative of staphylococcal infection. Sleeves or cylindrical dandruff comprise scales that form a cuff around the lash root and are connected with it, in contrast to greasy scales which are not connected to the lash root.[29] Sleeves indicate infestation with Demodex folliculorum.
It is an impulse-controlled disorder characterized by compulsive plucking or breakage of hair.[91] The most frequent site of hair pulling is the scalp, but the eyebrows, eyelashes, and pubic hair may also be involved. Trichotillomania manifests in eyelashes and eyebrows as irregular patches of alopecia containing hairs of varying lengths. Inflammation, scarring, and atrophy are conspicuous by their absence. Patients often attempt to conceal their alopecia by cosmetological camouflage. In case of a diagnostic dilemma, histological features such as increased numbers of catagen hairs, pigment casts, and traumatized hair bulbs provide a clue.
In extreme cases, such as disordered eating and anemia, an iron deficiency may be to blame for thinning brows. “Even if you don’t have anemia, and you have low levels of stored iron, that could contribute to hair loss,” says Rajani Katta, M.D., a dermatologist and clinical assistant professor of medicine at Baylor College of Medicine, who studies the link between nutrition and hair loss. Iron is found in meat, fish, and other animal products, plus beans and legumes, so vegans and vegetarians might be more likely to be low in iron. Your derm can do a ferritin blood test to check your iron levels. But don’t start an iron supplement without medical recommendation. Too much iron can also have negative effects, says Dr. Katta.
When this process is disrupted you end up with thinner hair, increased hair loss, a failure to regrow new hair and all in all a super sad experience! No one love losing their hair and it’s such a huge source of upset for women I work with but I’ll be honest, it is often the last thing to change as we work through getting your hormones and metabolism more balanced. It’s simply not your body’s priority.
There are numerous diseases that can affect the hair and scalp. Hair loss can be caused by a variety of conditions. Diseases such as alopecia areata, anemia, male/female pattern baldness, and infections of the scalp can all cause significant difficulty and loss of daily well-being. Stanford Dermatology has established a special clinic focusing on the diagnosis and treatment of these disorders of the hair.
Hansen's disease, also known as leprosy, is an infection of the skin and nerves caused by the bacterium Mycobacterium leprae. The disease often affects the skin of the eyebrow region, leading to loss of sensation and permanent loss of the eyebrow hairs. There are numerous other rare and uncommon causes of eyebrow hair loss, including vitamin A toxicity, nutritional disorders and other dermatological disorders. If you experience loss of eyebrow hair, see your doctor to evaluate the cause and to discuss a treatment plan.
Additionally, two other considerations are important for a patient who receives treatment for FPHL. First, there is a set of reasonable expectations in patients. Maintaining the current hair density can be considered a successful treatment because women tend to have further thinning as they age (Harfmann and Bechtel, 2015). Second, it is important to ensure that patients understand that progress is slow, and months or years can be required to see a significant improvement (Boersma et al., 2014, Yeon et al., 2011). In our practice, we wait at least 6 months to assess treatment efficacy.
Hansen’s disease – Hansen’s disease, popularly known as leprosy could cause loss of eyebrows. This condition is cause by infection of a bacterial known as mycobacterium leprae and if it affects your eyebrows region, you expect to lose some eyebrows i.e. if it affects your eyebrow skin region, a place it often afflicts, you could suffer from permanent eyebrow hair loss as ‘Tulay Cakiner-Egilmez, Ph.D., R.N’ reports in ‘Journal of the American Society of Ophthalmic Registered Nurses’. This and other infections that can cause loss of eyebrows.
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I’m no Frida Kahlo, but since my teenage years, I’ve been blessed with thick, full eyebrows. But as soon as I turned 30, I noticed something was amiss. My beautiful brows were looking, let’s say, sparse. Every time my brow specialist handed me a magnified mirror after my monthly wax, it seemed I had more patchy spots. My low-maintenance morning routine—a quick brush-up and pencil fill-in—was suddenly taking up a lot more time. I found myself on a constant quest for the best brow powders, pencils, and gels, and started researching microblading in hopes of finding a solution.
To prove the fact that this does not happen on your scalp alone, Everyday Health notes, “too much thyroid hormone, the hair on your head can become fine, with thinning hair all over the scalp. When there is too little of this hormone, there can be hair loss, not just on the scalp, but also anywhere on the body”. This proves patients with underactive thyroid (low thyroid) can have their eyelashes and eyebrows falling off.
Taking estrogen supplements as part of a hormone replacement therapy regime has its effects on your hair as well. Women can treat a type of hair loss called androgenic alopecia, associated with low estrogen and progesterone, by replacing these hormones artificially. Dosages of synthetic estrogen should be monitored regularly -- abnormal hair growth is a possible side effect of one kind of hormone replacement therapy, called esterified estrogens.
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Thyroid hormone receptors were detected in both dermal and epithelial compartments of the human pilosebaceous unit.[48] T4 and T3 decrease the apoptosis of hair follicles and T4 prolongs the duration of anagen in vitro.[49] Thyroidectomy delays initiation of anagen. Administration of thyroxine advances anagen, initiation of which is however delayed once toxic doses are given. Therefore, ratio of telogen to anagen hairs is increased in hypothyroidism as well as hyperthyroidism.[50] Thus, the hair follicles are affected in thyroid disorders, and madarosis is caused due to disturbances in hair cell kinetics. Hypothyroidism is associated with generalized hair loss probably due to coarse, dull, and brittle hair with reduced diameter.[51] The eyebrows and eyelashes may also be lost. Loss of lateral one-third of eyebrows known as Hertoghe sign[38] is a characteristic sign of hypothyroidism.[52] Some people also refer to it as Queen Anne's sign,[53] after Anne of Denmark whose portrait with shortened eyebrows has been interpreted by some as indicative of the presence of goiter, even though such a fact has not been proved by any known sources of information. Madarosis may even be the presenting sign in hyperthyroidism.[21] In hyperthyroidism, there is thinning with breaking off and shortening of hair.[54] Madarosis can also occur in hypopituitarism, hypoparathyroidism,[21] and hyperparathyroidism.[55]
Tames and Goldenring described a case of bilateral loss of eyebrows and eyelashes in a patient with AIDS-related complex who had smoked crack cocaine. This has been attributed to hot vapors during the process of smoking, and which therefore caused singeing of the brows and lashes. There was a complete reversal once the patient abstained from cocaine.[93]
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