Madarosis is a terminology that refers to loss of eyebrows or eyelashes. This clinical sign occurs in various diseases ranging from local dermatological disorders to complex systemic diseases. Madarosis can be scarring or non-scarring depending upon the etiology. Appropriate diagnosis is essential for management. Follicular unit transplantation has been found to be a useful method of treating scarring madarosis and the procedure relevant to eyebrow and eyelash reconstruction has been discussed. A useful clinical approach to madarosis has also been included for bedside diagnosis. The literature search was conducted with Pubmed, Medline, and Google scholar using the keywords madarosis, eyebrow loss, and eyelash loss for articles from 1960 to September 2011. Relevant material was also searched in textbooks and used wherever appropriate. 

Hypothyroidism, or an underactive thyroid gland, adversely affects scalp and body hair growth. Thinning of the eyebrows can be a late sign of hypothyroidism. Other symptoms of hypothyroidism include chronic fatigue, weakness, constipation, weight gain and skin dryness. Treatment of hypothyroidism with thyroid hormone replacement medication typically leads to regrowth of lost eyebrow hair.
Androstenedione, which is mostly produced in the ovary and adrenal glands, is converted to testosterone by 17β-hydroxysteroid dehydrogenase. Testosterone then circulates throughout the body to reach its target tissues. Androgen-metabolizing enzymes have been found in many parts of the hair follicle (Table 1; Bolognia et al., 2012). The presence of those enzymes makes the pilosebaceous unit a site of androgen metabolism and synthesis (Fazekas and Sandor, 1973). Circulating free testosterone either binds to intracellular androgen receptors in the hair bulb and dermal papilla, which facilitates miniaturization of the follicle, or is metabolized into dihydrotestosterone (DHT) by the enzyme 5-alpha-reductase. DHT then binds the same receptor but with much greater affinity (Kaufman, 2002, Levy and Emer, 2013). Of the androgens depicted in Figure 1, only DHT and testosterone bind to androgen receptors (Burger, 2002).

Traumas such as major surgery, poisoning and severe stress may cause a hair loss condition known as telogen effluvium, in which a large number of hairs enter the resting phase at the same time, causing shedding and subsequent thinning hair in men and women alike. The condition also presents as a side effect of chemotherapy. While targeting dividing cancer cells, this treatment also affects hair’s growth phase, with the result that almost 90% of hairs fall out soon after chemotherapy starts.

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.


Medicines may also help slow or prevent the development of common baldness. One medicine, minoxidil (brand name: Rogaine), is available without a prescription. It is applied to the scalp. Both men and women can use it. Another medicine, finasteride (brand name: Propecia) is available with a prescription. It comes in pills and is only for men. It may take up to 6 months before you can tell if one of these medicines is working.
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.
Although it’s generally only prescribed as a last resort for menopausal symptoms, hormone replacement therapy is a common and very effective hair loss treatment for some women — as long as they are menopausal or post-menopausal and are not at higher risk for adverse effects from HRT. It's most often prescribed for women who have androgenetic alopecia, also called pattern baldness. Hormone replacement therapy has a number of benefits for both general health and symptom management, but also a number of side effects — which range from unpleasant to dangerous.
Last week, we schooled you on the foods and vitamins for long, healthy hair. Today, Kristin Dahl, a Los Angeles-based nutritionist and women’s wellness educator, is back again to talk about all things hormones and hair loss. Keep reading for Dahl's guide to maintaining optimum hormonal balance, how stress can mess with your mane, lock-block hair growth, and more. As the founder of The Women’s Wellness Collective and the holistic lifestyle hub, Dahl House Nutrition, Dahl knows what she's talking about so we'd take notes if we were you. 
During pregnancy, high concentration of estrogen levels in women result in the development of thicker, stronger, longer and healthier looking hair. Following pregnancy however, women tend to fret and think that they’re losing their hair when in fact they’re merely shedding the excess hair that the excess oestrogen created. The hair that was in a prolonged anagen stage are now all shifting into telogen (resting phase) to make way for new hair growth. This type of hair loss is comes under the condition known as telogen effluvium but the good news is that when oestrogen levels have returned to normal, your hair will too.
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]
Take extra care in looking after your hair. Use a gentle, nourishing shampoo (we love Bumble and Bumble Gentle Shampoo) to promote good condition and prevent breakage. Try using a silk or satin pillowcase. Avoid harsh styling products and techniques that apply heat to the hair (blow drying, curling irons etc) as these can cause more damage to fragile hair.
Androgenetic alopecia, 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. While testosterone is at the core of the balding process, DHT is thought to be the main culprit.
When a woman is experiencing hair loss and has PCOS, spironolactone is often prescribed and it can be helpful but it’s important as well to address all these other issues when it comes to PCOS related hair loss. It’s also important to know that there is only a mild correlation of elevated testosterone on a blood test and hair loss. This is likely due to the hypersensitivity of the follicle to androgens in PCOS. Basically we get an exaggerated reaction from a smaller amount of testosterone.
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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.
Estrogen and combined oral contraceptive (COC) drugs with estrogen or progestogen have been reported as effective, but data are limited (Adenuga et al., 2012, Raudrant and Rabe, 2003, Scheinfeld, 2008). They are thought to function through several mechanisms. Both components of COC drugs increase the levels of sex-hormone-binding globulin (Schindler, 2013). They also send negative feedback signals that suppress the hypothalamic secretion of gonadotropin and releases the hormone and pituitary secretion of the luteinizing and follicle-stimulating hormones, which results in a decreased androgen production (Gilman et al., 1990, Varothai and Bergfeld, 2014). These actions decrease androgen secretion from the ovary and the quantity of free, biologically active androgens, which reduces their effects on the hair follicles (Schindler, 2013). Our practice when prescribing COC drugs is a combination of ethinyl estradiol 20 mcg plus drospirenone 3 mg. Drospirenone is an analogue of spironolactone. This treatment combination is approved by the FDA for the treatment of acne but not alopecia.
Your doctor might also suggest the prescription pill finasteride, sold under the brand name Propecia and also in generic versions. Although the drug is not federally approved for use in female patients, some doctors have observed good results in postmenopausal women. But women who are planning to have children should not take this drug because it can cause birth defects.
Hair loss may also occur due to dieting. Franchised diet programs which are designed or administered under the direction of a physician with prescribed meals, dietary supplements and vitamin ingestion have become popular. Sometimes the client is told that vitamins are a necessary part of the program to prevent hair loss associated with dieting. From a dermatologists’s standpoint, however, the vitamins cannot prevent hair loss associated with rapid, significant weight loss. Furthermore, many of these supplements are high in vitamin A which can magnify the hair loss.
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.

Madarosis is a terminology that refers to loss of eyebrows or eyelashes. This clinical sign occurs in various diseases ranging from local dermatological disorders to complex systemic diseases. Madarosis can be scarring or non-scarring depending upon the etiology. Appropriate diagnosis is essential for management. Follicular unit transplantation has been found to be a useful method of treating scarring madarosis and the procedure relevant to eyebrow and eyelash reconstruction has been discussed. A useful clinical approach to madarosis has also been included for bedside diagnosis. The literature search was conducted with Pubmed, Medline, and Google scholar using the keywords madarosis, eyebrow loss, and eyelash loss for articles from 1960 to September 2011. Relevant material was also searched in textbooks and used wherever appropriate.
If you’ve undergone chemotherapy recently, you know the effects that it has on your hair, including your brows and lashes. First of all, I want to point you to this awesome resource by FairyHairs (click here), that shows in intervals, with pictures, what you can expect with regrowing your hair after chemo (Thank you, Jenny Mealy!). The article also includes ways to regrow your hair after chemo.
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]

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.”
If you’re experiencing hair loss, topical treatments like minoxidil (Rogaine) and others tend to only be partially effective, if they are effective at all; they don’t address the root causes of hair loss; they target androgenic alopecia (which only accounts for some cases of hair loss); and they come with a host of unpleasant side effects—side effects that can worsen the aesthetic problem you were hoping to fix. Rogaine can cause hair to grow in different colors and textures than the surrounding hair and can cause unwanted hair to grow on your cheeks and forehead.

Although it’s generally only prescribed as a last resort for menopausal symptoms, hormone replacement therapy is a common and very effective hair loss treatment for some women — as long as they are menopausal or post-menopausal and are not at higher risk for adverse effects from HRT. It's most often prescribed for women who have androgenetic alopecia, also called pattern baldness. Hormone replacement therapy has a number of benefits for both general health and symptom management, but also a number of side effects — which range from unpleasant to dangerous.


There is some evidence of a link between baldness and prostate cancer and other diseases. Harvard Medical School reports that men with vertex baldness have 1.5 times more of a risk of developing prostate cancer than men without bald spots. The risk of coronary artery disease is also more than 23 percent higher in men with vertex bald spots. Investigations are ongoing as to whether there is a link between DHT levels and metabolic syndrome, diabetes, and other health conditions.
There’s no doubt that estrogen and hair loss are connected, but there are certain factors that determine how much of an effect estrogen levels have on your hair. As one of the main visible measures of your health, hair growth is often one of the first areas affected when hormones are off-balance. Let’s take a look at the links between estrogen hormonal imbalance and hair loss.
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