If you are in Maryland, especially in Rockville, Maryland, you could schedule an appointment with us and have your consultation. We would provide you with answers and treatments available for you and your skin condition. Contact us and let us know about your skin dilemma. Katz Dermatology has been serving Maryland for 40 years now and continues to provide quality of dermatology services especially in general dermatology, cosmetic dermatology, surgical dermatology and aesthetic dermatology.
Blepharitis is a chronic primary eyelid inflammation. It is fairly common in occurrence and being a condition with remissions and relapses, results in a decreased quality of life if adequate measures are not taken. Chronic blepharitis is the most common condition associated with madarosis.[10] Though there are various ways of classifying blepharitis, the most useful is the one proposed by Wilhelm,[24] wherein blepharitis can be classified based on whether there is a predominant involvement of the part of the eyelid anterior to the gray line (anterior blepharitis), or posterior to the gray line (posterior blepharitis). The gray line is an imaginary line dividing the eyelid into an anterior part consisting of the skin and muscle, and a posterior part consisting of the tarsus and conjunctiva.
Hypoproteinemia[71] causes loss of hair due to premature onset of telogen. Loss of eyebrow hair has been reported due to chronic zinc deficiency in a patient receiving only parenteral nutrition for 2 months.[26] Acrodermatitis enteropathica is an inherited disorder of zinc deficiency which shows loss of eyebrows and lashes in addition to cutaneous manifestations.[72,73] Biotin deficiency can result in encephalopathy, neurological disorders, skin desquamation, and loss of eyebrows and eyelashes.[74] Iron deficiency may be a possible cause for diffuse telogen hair loss; its exact role however is subject to speculation.[75]
Women using oestrogen supplementation or taking birth control pills will also experience hair loss when they cease supplying their body with extra oestrogen. These forms of hair loss may be temporary but this, however, does not mean that there is no link between oestrogen and permanent hair loss. Scientists have noted up to 30 hormones that could play a role in female pattern hair loss – the genetic kind of hair loss – and oestrogen, whilst poorly explored, may be one of them. It’s alright if the excess hairs are the ones that are lost but when normal hair falls out, there’s a problem.
Eight of 69 eyes receiving intra-arterial chemotherapy with melphalan for retinoblastoma were found to develop a cutaneous periocular erythema with partial loss of eyelashes.[110] Gobin et al. also reported a 12.6% incidence of madarosis following intra-arterial chemotherapy for retinoblastoma.[111] Moti and Fausel described a case of cyclical alopecia areata including the eyebrows and eyelashes after treatment with paclitaxel and carboplatin.[112] Other drugs which have been implicated in hair loss due to anagen effluvium are adriamycin, cyclophosphamide, daunorubicin, epirubicin, etoposide, ifosfamide, irinotecan, topotecan, vindesine, and vinorelbine.[98,113]
Eyebrow loss, also known as superciliary madarosis, can occur with a variety of medical conditions. Madarosis can affect one or both eyebrows with partial or complete hair loss. Infections, chronic skin disorders, hormone disturbances, autoimmune diseases and medications are among the many medical reasons for eyebrow loss. In most cases, identification and treatment of the underlying condition leads to regrowth of the eyebrows. Permanent eyebrow loss can occur with disorders that permanently damage the hair follicles.
Sinclair Scale: The 5-point Sinclair Scale is a modified visual grading scale. Grade 1 is normal. This pattern is found in all girls prior to puberty, but in only half of women age 80 or over. Grade 2 shows a widening of the central part. Grade 3 shows a widening of the central part and thinning of the hair on either side of the central part. Grade 4 reveals the emergence of diffuse hair loss over the top of the scalp. Grade 5 indicates advanced hair loss. This grade is uncommon, occurring in less than 1% of women.
Like with low thyroid, there can be a myriad of imbalances at play with PCOS related hair loss making it a complex issue that’s often written off as merely high testosterone. While androgen excess and hypersensitivity of the hair follicles to these hormones are part of the issue, these are other contributing factors to PCOS related hair loss as well:
Androgenetic alopecia, a type of hair loss commonly called male or female pattern baldness, was only partially understood until the last few decades. For many years, scientists thought that androgenetic alopecia was caused by the predominance of the male sex hormone, testosterone, which women also have in trace amounts under normal conditions. But while testosterone is at the core of the balding process, dihydrotestosterone (DHT) is now thought to be the main culprit.
FPHL or androgenetic alopecia is the most common cause of hair loss in women and one of the most common chronic problems seen by dermatologists worldwide (Varothai and Bergfeld, 2014). FPHL is a nonscarring form of alopecia in which the frontal hairline is maintained, but there is progressive hair thinning at the vertex of the scalp. Thinning of the hair is secondary to alteration of the hair cycle with shortening of the anagen phase and simultaneous lengthening of telogen. This increase in the resting phase and decrease in the growth phase of the hair cycle results in the miniaturization of hair because long terminal hairs are gradually replaced by short vellus hairs (Messenger and Sinclair, 2006, Sinclair et al., 2011).
Topic prostaglandin analogues are used for the treatment of glaucoma. Uniocular increase in length, thickness, and pigmentation of the lashes were described by Johnstone in 1997 by patients using latanoprost in one eye.[184] There are reports of a response of alopecia of eyelashes to cutaneously administered latanoprost,[185,186] though others report limited success.[187] Eyelash growth has also been reported following bimatoprost 0.03% topically to the base of the eyelashes in healthy individuals[188–190] and in individuals with alopecia areata.[191] Bimatoprost ophthalmic solution 0.03% is the only Food and drug administration (FDA)-approved product to safely and effectively enhance the growth of a patient's own eyelashes.[192,193]
Atopic dermatitis is a form of eczema that causes red, itchy patches of skin. Involvement of the skin around the eyes can lead to swelling, skin inflammation and loss of the eyebrow hairs, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Skin-irritating cosmetics and soaps may aggravate atopic dermatitis. The eyebrows often regrow when the condition becomes inactive.
Telogen effluvium, a type of scalp hair loss characterized by hair shedding, may affect the eyebrows as well. It can be caused by any emotional or physiological stress, for example acute or chronic illnesses, hormonal changes, nutritional deficiencies, and medications that alter the normal hair cycle and cause the hair the enter the telogen phase prematurely.
Other conditions, which can cause eyebrow hair loss, include infection by a number of fungal infection, which are common, both on your scalp and eyebrow areas, affliction by pests such as lice, which will cause itching, and scratching. Infiltrating disorders such as scars, alopecia mucinosis, and sclerosing disorder could also cause brow hair loss. If you are heavily using any of the following drugs, they could also cause eyebrow hair loss: 

Male pattern hair loss has been established as androgen-dependent because it is associated with changes in the androgen receptor and responds to antiandrogen therapy (Ellis et al., 2002). With FPHL, genes that encode aromatase, which converts testosterone to estradiol, are also implicated (Yazdabadi et al., 2008, Yip et al., 2009). The process of androgen biosynthesis is depicted in Figure 1.
Low estrogen levels are most common during menopause, but it can happen to women at any age. As estrogen levels decline, the greater influence of testosterone shortens the growth phase, and the subsequent hair loss is usually gradual but can become noticeable over time. Hair loss caused by changing estrogen levels tends to be visible all over the scalp or evident in a widening part, rather than missing patches of hair or a horseshoe pattern as with male pattern baldness.
Giorgos Tsetis: When you want to solve an issue, you must first thoroughly understand the problem. A lot of times, especially in the pharma world, everybody is trying to identify the magic pill that targets a single trigger. But, that's the exact reason there hasn't been a drug that holistically and indefinitely ends the problem. You can't zero in on one specific trait or symptom, you really have to solve for the many causes. When it comes to hair loss for men and women, there are several causes that disrupt the natural hair growth cycle. Basic vitamins and minerals only act as a temporary bandaid for hair health deficiencies, which is simply not enough. Hair loss and thinning hair means your body is imbalanced and there's something off, because hair follicles are mini organs.
Another cause of eyebrow hair loss is genetic predisposition. Many patients naturally have thinner eyebrows that run in their family. This is one of the biggest reasons patients seek our services. Medical conditions such as hypothyroidism, eczema, and alopecia areata (spot baldness) can also lead to brow hair falling out. It’s important to determine the cause of your condition to find an effective treatment. 

The different phases may last for varying periods of times from several years in anagen, to a few months in telogen or several weeks in anagen. Fortunately not all hair follicles are in the same phase at the same time. So the majority of the follicles will be in anagen phase, while a smaller amount will be in the catagen phase and a few follicles will be in the telogen phase. This ensures that there is always some hair present even when the follicle is not active and the hair is not growing.

This article was very informative for me. I am a 56 yr. old male struggling with high estrogen levels and low T. My last blood test taken last week my estrogen level was 100 and my T was 700 its climbing because I am taking testosterone inj. Twice a week at 50mg per inj. I’m also taking Anastrozole 1/10 tab 5 days a week. I just started on that. Its only been 2 days for the estrogen blocker. My belly fat is increasing and I’m feeling and looking extremely bloated. I’m depressed because of the weight gain and the way I now look. My healthy weight is 153 I’m 5’8″ but now I’m 178lbs. I’m also constipated and feel there is a lot of food not passing through, please let me know which part of this is normal and will the Anastrozole start working gradually and cut my belly fat out? My diet is high fiber, low carbs. I am working on working out more often. I’m a non smoker and non drinker.


Skin infections can cause hair loss at the affected area. One of the more common causes is a fungal infection of the skin, also sometimes referred to as a ringworm. Eyebrow fungus is more likely to be related to a scalp fungus (tinea capitis) and both areas are often affected at the same time. A bacterial infection is another possible cause. Folliculitis for example is a condition where the hair follicle becomes infected usually with bacteria like Staphylococcus aureus. Eventually this can lead to loss of the hair in the infected follicle.

If you are suffering from hair loss on your head AND your brows, you might be suffering from a protein deficiency of some sort. A supplement like Viviscal (available here), which is packed with marine protein, could help your condition. Viviscal has been shown to treat alopecia areata, as well as androgen-related hair loss (Journal of International Medical Research, 1992; FutureDerm). It will take some time, though: changes in protein in the diet have been shown to correspond with protein in the hair within 6-12 months (American Journal of Physical Anthropology, 1999; Futurederm). 

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Hair loss is one of the most irritating and worrisome issues anyone would ever have to meet with. It is obvious that there are various reasons which may cause hair loss in individuals. One of the causes of hair loss can be a low level of estrogen hormone. There is a connection between estrogen and hair loss. In this current article, we will talk about if low estrogen can cause hair loss and also know of ways to prevent it. Hope this would be a beneficial read for you.
There is also a different in the form of 5AR enzyme (5 alpha reductase) found on the facial hair follicles vs. the scalp hair follicles. This enzyme converts testosterone into that more problematic DHT. Type I DHT is found in sebaceous glands on the face and genital area whereas Type II is found in hair follicles of the scalp. Type II DHT is typically more of a problem in men, but Type II is increased in disorders with high testosterone like PCOS. 

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.
It is important to understand the phases of hair growth which play an important role when in further understanding some of the causes of hair loss. During the active phase known as anagen the cells multiply at the follicle and push out to form the shaft. It is followed by a transitional phase known as catagen where the outer layer of the hair shrinks and it becomes attached to the root. Thereafter there is a resting phase known as telogen where there is no growth or changes in the hair.
Exercise is a key component of a healthy lifestyle. You’ll feel stronger and happier once you incorporate exercise into your daily routine. It also helps prevent some of the other symptoms of menopause, including mood swings, weight gain, and insomnia. All of these factors are important for maintaining hormonal balance, which promotes healthy hair growth.

So, if you have a similar paranoia—fear not! Losing strands is totally normal. But Dr. Wexler is quick to add that things like over-tweezing (it causes scarring to the follicles), waxing, severe weight-loss, stress, excessive touching, hormonal changes, and auto immune disease can cause irregular brow hair loss. If you believe your case may be extreme, it's best to see a specialist. 

Scalp hair loss may be a common complaint among men and women, but in my practice, loss of eyebrow hair is a major concern among my female patients. Because eyebrows frame the face, hair loss in this area can dramatically change one's appearance, and since eyebrow hair loss is not easily concealed, it can be, for some women, an even more devastating loss than scalp hair loss.
Eyebrows protect the eyes from sweat that trickles down the forehead. They also protect the bony ridges above the eyes. In addition to the above, the eyebrows play a very important function in facial expression and body language. Eyelashes protect the eyeball from small foreign bodies and irritants and stimulate the closing reflex. Both eyebrows and eyelashes play a very important cosmetic function, and thus contribute greatly to the self esteem of an individual.[9]

Reproductive hormone changes can also play a part, and dermatologists believe the same factors that cause hair loss from the scalp, a common problem for women as they age, may contribute to thinning brows. Nanette Santoro, M.D., ob/gyn and professor of reproductive endocrinology at the University of Colorado at Denver, says, “Abrupt hormone changes can cause sudden hair loss (telogen effluvium) that recovers over about six months' time. It happens postpartum to many women and can happen at menopause.”
The majority of women with androgenic alopecia have diffuse thinning on all areas of the scalp. Men on the other hand, rarely have diffuse thinning but instead have more distinct patterns of baldness. Some women may have a combination of two pattern types. Androgenic alopecia in women is due to the action of androgens, male hormones that are typically present in only small amounts. Androgenic alopecia can be caused by a variety of factors tied to the actions of hormones, including, ovarian cysts, the taking of high androgen index birth control pills, pregnancy, and menopause. Just like in men the hormone DHT appears to be at least partially to blame for the miniaturization of hair follicles in women suffering with female pattern baldness. Heredity plays a major factor in the disease.
Hormones are cyclical. Testosterone levels in some men drop by 10% each decade after age 30. Women's hormone levels decline as menopause approaches and drop sharply during menopause and beyond. The cyclic nature of both our hair and hormones is one reason hair loss can increase in the short term even when you are having a long-term slowdown of hair loss (and a long-term increase in hair growth) while on a treatment that controls hair loss.
Low estrogen levels are most common during menopause, but it can happen to women at any age. As estrogen levels decline, the greater influence of testosterone shortens the growth phase, and the subsequent hair loss is usually gradual but can become noticeable over time. Hair loss caused by changing estrogen levels tends to be visible all over the scalp or evident in a widening part, rather than missing patches of hair or a horseshoe pattern as with male pattern baldness.
When compared with no treatment, patients who received ethinyl estradiol 50 μg and cyproterone acetate 2 mg with cyproterone acetate 20 mg on days 5 to 20 of the menstrual cycle for 1 year had a significant increase in their percentage of anagen hairs with trends toward a larger shaft diameter of full anagen hairs and a decreased number of hairs that were less than 40 microns (Peereboom-Wynia et al., 1989). A 12-month randomized control trial of 66 women compared treatment with topical minoxidil 2% plus an oral contraceptive (ethinyl estradiol 30 μg + gestodene 75 μg) with treatment with cyproterone acetate 50 mg plus an oral contraceptive (ethinyl estradiol 35 μg + cyproterone acetate 2 mg) and demonstrated that treatment with cyproterone was more effective in hyderandrogenic patients but otherwise less effective (Vexiau et al., 2002). Side effects of cyproterone acetate include weight gain, breast tenderness, and a decreased libido (Kelly et al., 2016). Hepatotoxicity and development of multiple meningiomas may occur when doses exceed 25 mg daily (Medicines and Healthcare products Regulatory Agency, 2009). Cyproterone acetate is used widely in Europe and Canada, either in an isolated form or in combination with ethinyl estradiol, but it is only available in the United States as an orphan drug for the treatment of hirsutism (Carmina and Lobo, 2003, Jurzyk et al., 1992, Kelly et al., 2016). Cyproterone acetate is classified as pregnancy category X.

THE TREATMENTS If no trigger is present, it’s likely you have androgenetic alopecia, a hereditary condition that causes the hair follicles to get progressively thinner over the years. The most effective topical medication for the condition is minoxidil (brand name Rogaine), the only treatment for hair loss in women that has been approved by the Food and Drug Administration.


In this section, our Houston Hair Transplant Team discusses current trends in hair loss and restoration research with published experts. We choose our interviewees based on those who have had NIH or Medline indexed published medical research that is peer-reviewed. The list will be organized by country and then alphabetically by physician last name. Click on the name to read about the latest research in thinning hair and hair restoration from around world. We thank our specialists below for giving us the valuable time and sharing of insight. We are deeply grateful and honored to have had the privilege to get the insight provided by these world renown specialists
A number of skin and hair disorders can lead to eyebrow hair loss and sometimes it may be linked to systemic diseases like lupus. Specific skin and hair disorders that are most likely to lead to eyebrow thinning and hair loss have been discussed below but other conditions like psoriasis may also be involved if it occurs on the eyebrow or forehead. Eyebrow hair loss may occur in people on chemotherapy (cancer medication) and with radiation therapy to the head.

Well, maybe that’s a new adage from instagram, but it’s true all the same: eyebrows are the essential defining feature of every woman’s face. That’s exactly why eyebrow loss can feel like a death sentence to the beauty-conscious woman. With thick, lush eyebrows in style, eyebrow loss can feel more traumatizing than ever. Hair one day, gone the next!
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.

Liver support: is necessary to eliminate unneeded wastes from the body. Everything we take in is processed through the liver and toxins are broken down into water soluble byproducts so they can be moved into the intestine and pulled into the stool for elimination. Foods like cruciferous vegetables (kale, broccoli, collard greens) and lemon support the liver detox pathways. Herbs like milk thistle, dandelion root, and burdock root help to support  liver cleansing.
If, however, you aren’t so sure that any of the causes listed above are a problem for you, then a good place to start may be to talk with your healthcare provider about testing. It is important to learn the root cause – especially if dealing with infertility – because that which is causing hair thinning and shedding may also be contributing to your inability to conceive.
The first step in treatment is to identify the cause of the hair loss. Then, treat it appropriately. If an internal cause is the culprit, it should be addressed — for example, thyroid medication for thyroid disease or supplements for a nutritional deficiency. External skin conditions are often treated with topical medications, and, once treated, the hair loss usually recovers. I often recommend Latisse as an adjunctive treatment. Though frequently associated with eyelash lengthening, it is a great option for thickening brows. In fact, people with brows that thin with aging (I typically don't see this in women under 50) may want to opt for Latisse.
Hair loss is a condition that can affect any area of the body, including the eyebrows. Approximately three million Americans experience brow hair thinning and loss. Trauma, grooming habits, disease, and genetic predisposition all can contribute to this concern. Our experienced hair restoration surgeons at Leonard Hair Transplant Associates, Dr. Robert Leonard and Dr. Matthew Lopresti, often see individuals with eyebrow hair loss for which they offer a comprehensive selection of restorative options that can help you address this problem.
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