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.
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:
Insulin, that helper hormone in charge of regulating blood sugar levels, also affects a number of different body processes, including fat storage, heart health and, you guessed it, hair growth. One study published in the European Journal of Cardiovascular Risk found that women with some markers of insulin resistance have a greater risk for androgenic alopecia (AGA), or female pattern baldness.
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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
The hormonal process of testosterone converting to DHT, which then harms hair follicles, happens in both men and women. Under normal conditions, women have a minute fraction of the level of testosterone that men have, but even a lower level can cause DHT- triggered hair loss in women. And certainly when those levels rise, DHT is even more of a problem. Those levels can rise and still be within what doctors consider "normal" on a blood test, even though they are high enough to cause a problem. The levels may not rise at all and still be a problem if you have the kind of body chemistry that is overly sensitive to even its regular levels of chemicals, including hormones.

Staphylococcal blepharitis causes lid margin inflammation and folliculitis which destroys the hair follicle resulting in madarosis[30] which is usually non-scarring,[10] but occasionally may be scarring, especially if long standing.[15] Seborrhoeic blepharitis is very often associated with secondary bacterial infections and can result in madarosis either due to associated staphylococcal infection or due to rubbing caused by itching.


“…a beauty editor told me she had been using Viviscal... Since beauty editors see truckloads of products every week, I was immediately convinced when she said it worked – so I bought it myself. I started taking it twice a day for the first six months and saw dramatic results within three to four months. My hair was less thinned out …and it was also less brittle. I’ve gone to the same hairdresser since I was 19, and he was the first to comment on how full and strong my hair looked…”
Various techniques have been described over the years. Nylon implants were used by some people. Now, they are banned in many countries because of sequelae-like scarring and infection. Follicular unit transplantation has been found to give very good results[195] and is now the procedure of choice for most types of hair transplantation. The details of the procedure with respect to eyebrow and eyelash reconstruction will be discussed here.

Estrogen, the power player in women’s bodies, is your friend when it’s appropriately balanced. It makes you feel energized, helps stabilize your moods and contributes to a healthy sex drive. Yet too much estrogen, which can be caused by weight gain, perimenopause or toxicity from exposure to endocrine disruptors (which are rampant in our food, water and plastic products), can lead to thinning hair. During and after pregnancy, for example, estrogen levels peak and then dip, causing sudden hair loss for many women.
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.

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.


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.
The complex actions of genetics, DHT, shifting of hormone ratios and age-related volume loss can commonly occur in women in their 40’s and 50’s. However, just like in men, genetic hair loss can appear at all ages after puberty.  In fact, hair loss occurs with relatively high frequency even in women in their 20’s and 30’s. The majority of women with female pattern hair loss initially develop diffuse thinning over the front and top of the scalp, while maintaining the frontal hairline. This thinning may present with a widening through the central part line while others may present initially with either episodic or continuous hair shedding, prior to any noticeable decrease in hair volume. In addition, thinning may also be seen throughout the scalp, including the temple areas as well as the back and sides.

Seborrheic dermatitis is a condition where you have itchiness in the eyebrows.. like serious, serious itchiness. First of all, if you think you have this: see a derm, stat. You need a derm to confirm (can I trademark that saying?), and you definitely need a derm for the prescription. A dermatologist will tell you to treat the seborrheic dermatitis with a combination of desonide cream and ketoconazole cream twice daily for one week. Or, they may tell you to use a ketoconazole shampoo to control the problem. 

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. 


The hormone imbalance known as hypothyroidism is a common cause of abnormal eyebrow thinning, especially in women; roughly 27 million Americans suffer from thyroid disease, and about 80 percent of them are women. Thinning eyebrows appear as a symptom of both hypothyroidism (underactive thyroid production) and hyperthyroidism (overactive thyroid production), alongside issues such as excessive fatigue, difficulty losing weight and constantly feeling cold. If your brows appear particularly thin around the edges, visit your doctor for a thyroid screening, which should include thorough blood work. With prescription medication, your eyebrows should fill back in over the ensuing months.
If you have a case of estrogen dominance, you can help bring your levels down to normal by keeping your gut healthy and avoiding refined carbohydrates like white bread and white rice. Also, avoid eating any meat that has been treated with hormones. If you have low levels of estrogen, solutions include minimizing your stress, practicing a healthy diet, and exercising regularly.
Here is one small European study which looked at 20 pre-menopausal women with female pattern hair loss to check their serum levels of estradiol, free and total testosterone, SHBG, LH, FSH, and DHEAS. These levels were compared to those of a control group without hair loss. Estradiol is one of the three naturally occurring forms of estrogen found in the body.

Management of madarosis primarily depends upon treatment of the predisposing disorder. Inherited disorders can be identified by the associated clinical features. Establishing the diagnosis is an important prerequisite for the management of madarosis. For this, madarosis can be broadly classified as scarring and non-scarring. In non-scarring madarosis, generally regrowth of hair occurs after treatment of the primary disorder. In disorders such as lepromatous leprosy, though the madarosis is non-scarring, hair regrowth does not occur. In such cases, and in cases of scarring madarosis, hair transplant is essential for cosmetic purposes.

See a dermatologist for itchy skin or rashes around your brows. These patches may indicate a skin infection or interaction with a new beauty product or environmental trigger. You could also have inflammation from dermatitis or psoriasis.[32] These conditions don’t actually cause hair loss, but they can lead to it if you rub and scratch the affected areas.

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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