About Superciliary Madarosis

 

Eyebrow loss, also known as superciliary madarosis, can occur with a variety of medical conditions. Madarosis is derived from the ancient Greek word "madaros" meaning "bald" and is defined as hair loss of the eyebrows (superciliary madarosis) or loss of eyelashes (ciliary madarosis). Loss of eyelashes is also known as milphosis. 

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 many medical reasons for eyebrow loss. In most cases, identification and treatment of the underlying condition can lead to regrowth of the eyebrows, however in many cases; growth is slow, sparse or nonexistent. Permanent eyebrow loss can occur with disorders that permanently damage the hair follicles. Other causes of permanent hair loss in the eyebrow region involve aggressive eyebrow hair tweezing and burns.  The cosmetic effect especially on a woman can be devastating. 

Etiology and Associations of Madarosis 

 

1.       Inflammation

Inflammation of the eyelids (blepharitis) can cause loss of eyelashes. It can be due to infection, skin disorders, trauma or allergy.

Infections:   Fungal infections and lice impede your skin's ability to allow hair through the follicles.  These infections can cause follicular inflammation which produces edema and results in easier epilation of facial hairs. It also affects cilia construction so that eyebrows and lashes become brittle and fall out. 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. 

Skin Disorders:  Common chronic skin disorders can cause eyebrow hair loss. These skin conditions cause inflammation and irritation that can lead to hair falling out or the hair can fall out due to itching. Eczema (atopic dermatitis) is characterized by extremely dry skin with itchy red patches and scaling. Psoriasis involves an abnormally rapid life cycle of skin cells leading to accumulation of dead cells, redness, thick scales and irritation, while seborrheic dermatitis, also known as seborrhea or dandruff, can affect facial hair as well as scalp hair.

Trauma:  Trauma from rubbing or plucking may be the cause of unilateral or bilateral lash loss.

Allergy:   Contact dermatitis is an allergic skin reaction to substances.  The loss of eyebrows or lashes may be secondary to allergy to the use of eye cosmetics such as eyebrow gel and mascara. Waterproof products are the most difficult to remove and can take too many eyebrow hairs and lashes with them.

 

 2.       Autoimmune disorders

Alopecia Areata is a chronic autoimmune disease in which the immune system erroneously attacks the hair follicles, causing inflammation and temporary hair loss. Any hair-bearing skin site can be affected by Alopecia Areata, including the eyebrows and eyelashes. Treatment commonly involves corticosteroid injections into the site of eyebrow loss, according to the American Academy of Dermatology. Eyebrow hairs usually grow back, but may be a different color or texture than the lost hairs.

Discoid Lupus Erythematosus (DLE) usually presents with lesions on the sun-exposed areas. Periocular involvement occurs uncommonly and may progress from eyelid erythema to scarring and madarosis. However, madarosis may be the presenting sign of DLE in the absence of any history of preceding erythema and scarring and should therefore be considered in the differential diagnosis of chronic blepharitis that persists despite usual medical management and eyelid hygiene. Madarosis has also been reported to occur in systemic lupus erythematosus and scleroderma.

Vitiligo, a chronic autoimmune skin disorder that results in patchy areas of de-pigmentation, can cause eyebrow hair to lose pigment as well and turn gray. Vitiligo also can cause inflammation that leads to eyebrow hair loss.

 

 3.       Tumors

Benign and malignant tumors of the eyelids such as chalazion, squamous cell carcinoma, basal cell carcinoma, sebaceous carcinoma, lymphomas and sclerosing sweat duct carcinoma of the eyelid can present with loss of eyelashes.

 

4.       Endocrine disorders

Hair follicle activity is affected in pathologic states such as hypothyroidism or hyperthyroidism. Changes of hair growth and hair structure may be the first clinical sign of a thyroid hormonal disturbance as a result of the influence on the cell cycle kinetics of the hair follicle cells. In hyperthyroidism, hair changes include thinning, breaking off, shortening of the hair and patchy areas of hair loss. Eyelash loss has been reported as an early sign in hyperthyroidism. In hypothyroidism, the hair may become dull, brittle and coarse, with reduced diameter and may involve the eyelashes and brows. Madarosis may also be associated with hypopituitarism and hypoparathyroidism. Treatment of hypothyroidism with thyroid hormone replacement medication typically leads to regrowth of lost eyebrow hair.

 

5.       Congenital causes

Loss of eyelashes, in association with other ocular abnormalities, has been reported in congenital ichthyosiform erythroderma, lamellar ichthyosis, hereditary ectodermal dysplasia syndrome, congenital atrichia, cryptophthalmos, Ehlers Danlos syndrome and lid coloboma.

 

 

6.       Drugs, Toxins and Chemotherapy

Some medications, both prescription and over-the-counter, can interfere with eyebrow-hair growth. Hormone-altering medications, such as birth control pills, are common culprits, as are anti-seizure medications and anti-depressants. Over-the-counter medications like ibuprofen and acetaminophen can also interfere with hair growth when taken in large quantities.

Some cancer chemotherapy drugs cause temporary hair loss, which affects all body hair. Along with the loss of scalp hair, people undergoing chemotherapy also commonly lose their eyebrows and eyelashes. Chemotherapy drugs that frequently cause hair loss include paclitaxel, 5-fluorouracil, carboplatin, cisplatin, actinomycin-D, bleomycin, vincristine, cyclophosphamide, altretamine, etoposide and doxorubicin, reports the Abramson Cancer Center of the University of Pennsylvania. Hair loss typically begins two to three weeks after the start of chemotherapy. Lost eyebrow hair regrows in the weeks to months following completion of treatment.

Idiosyncratic reaction resulting in unilateral madarosis and facial alopecia has been reported secondary to long-term use of Botulinum A injections for orofacial dystonia. Drugs such as miotics, anticoagulants, anticholesterol drugs, antithyroid drugs, boric acid, bromocriptine, propranolol, valproic acid and chronic epinephrine therapy have been reported to cause loss of eyelashes.

Heavy metal poisoning is less common than in the past because of government control of ingredients and chemicals, but it can still be an issue in some areas. Compounds like iodine, arsenic and mercury can cause hair loss when ingested in large amounts.  Ciliary madarosis has also been reported following cocaine use.

 

7.       Vitamins and Minerals

Taking more than the recommended dosages of some vitamins and minerals can cause hair loss. In particular, B vitamins and vitamin A interrupt hair growth in large doses.  Intoxication with arsenic, bismuth, thallium, gold, and quinine can also cause loss of eyebrow hair and eyelashes.

 

8.       Psychiatric causes

This includes trichotillomania which refers to a rare form of hair/eyelash loss resulting from avulsion of hairs by the patient. It is characterized by compulsive pulling out of one's hair associated with tension or an irresistible urge before pulling, followed by pleasure or relief. The hairs are broken at different levels, they may be tufted, tortuous and some hair fibers may be abnormally longer than others. The hair follicles may be prominent.

 

9.       Miscellaneous

Dermatological conditions such as acanthosis nigricans can be associated with ectodermal defects. Familial acanthosis nigricans has been reported with madarosis. Loss of eyelashes has also been reported in association with Vogt-Koyanagi syndrome. Other causes may include: epidermolysis bullosa, rosacea, psoriasis, metabolic diseases such as mitochondriopathy, adrenoleukodystrophy, malnutrition, Meige syndrome, sickle cell anemia, HIV infection, post- proton beam irradiation for tumors of the choroid of the eye, eyelid tattooing, thermal injury and cryotherapy.

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