When you see more hair in the shower drain, in your hair brush or your ponytail holder goes around an extra time all of a sudden this is typically low thyroid, high stress or low estrogen. It can also be the increased inflammation or oxidative stress or as a result of nutrient deficiencies especially anemias (low iron, B12, etc.). Let’s dig into each of these.
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Other hair loss conditions that may be of an autoimmune nature that can involve the loss of eyebrows such as an underactive thyroid or vitiligo are termed “markers of underlying conditions”. It would be a trichologist’s responsibility to highlight these to the GP for further testing, these can also be investigated privately. In addition, there are conditions such as nutritional deficiencies like pernicious anaemia (unable to store B12) and of course anxiety and stress hair loss which can cause an overall reduction in the hair density. Patients attending with this concern often report that their general density is less dense.
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There is pilosebaceous inflammation with both scarring and non-scarring alopecia depending on the degree of inflammation. Most commonly, there is involvement of the head and neck, though widespread involvement is also seen. Eyebrow loss is a prominent finding and may be the presenting symptom when the eyebrow region is involved in the acute benign form of follicular mucinosis.
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This manifests in childhood with chronic lower eyelid dermatitis and is often associated with other types of allergic disorders.[36,37] The ocular features are eyelid dermatitis, Dennie-Morgan fold (an infraorbital fold or line due to lid edema in atopic dermatitis), keratitis, and a frequent association with keratoconus and cataracts. Loss of lateral third of eyebrows (Hertoghe sign) is seen in atopic dermatitis due to constant scratching and rubbing.
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:
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.
It takes more than just an apple a day to keep the doctor away; if your diet lacks the key vitamins A, B, D and E or nutrients such as iron, calcium or the amino acid L-lysine, your hair may suffer. Nutrient deficiency doesn’t just affect the eyebrows—it may lead to hair loss on the scalp, feelings of fatigue and physical weakness, lightheadedness or inhibited concentration, heart palpitations and pale skin, among other serious symptoms.
Because too much insulin (which is released by the pancreas in large amounts when we consume foods high in sugar or refined flour) signals the ovaries to produce more testosterone, and because an overload of testosterone increases the likelihood that our bodies may make more of the hair-thinning hormone DHT, work to keep blood sugar steady by eating fiber-rich whole foods. In addition, the Saw Palmetto herb has shown promise for its ability to block the conversion of testosterone into DHT, so it may help androgen-related hair loss. To date, research on saw palmetto for hair loss is limited, but the research that has been done is promising.
MICHAEL REED, MD: Over-the-counter minoxidil, which is the brand Rogaine, is FDA approved. It's been shown to be effective in scientific studies. Propecia is the new drug on the block, and that probably is more effective. It's a pill that you take once a day, and that has been shown to slow down hair loss and grow hair in a significant number of individuals. Most of the other preparations that are heavily advertised or marketed are not proven to be effective.