Knowing All About Madarosis: Diagnosis, Treatment, Prevention

Madarosis is a condition that causes loss of eyebrows (superciliary madarosis) or losing eyelashes (ciliary madarosis). It can affect one side of the face or both sides of the face. The terminology is derived from an ancient Greek word ‘Madao’ which means ‘to fall off. 

Along with adding to one’s aesthetic appearance, eyebrows and eyelashes are there for a reason. They prevent bacterias, irritants, or foreign material from entering your eye. They play an important function in body language and facial expressions. 

Eyebrows protect our eyes from sweat or rain. Both eyelashes and eyebrows are important cosmetic functions, losing hair can affect a patient's self-esteem. 

The condition may lead to partial or complete loss of hair from your eyelashes or eyebrows. This means that either the condition can lead to thinning of hair or complete loss.

Madarosis can be scarring or non-scarring. Scarring means there is permanent damage to your losing eyelashes or eyebrows. Non-scarring means there is a temporary loss of hair from your eyelashes or eyebrows. 

Losing eyelashes alone is called milphosis. Madarosis can be a manifestation of local or systemic diseases. Continue reading to know all about madarosis.

The main symptom of madarosis is the loss of hair follicles from your eyelashes, eyelid, or eyebrows. Patients may have redness or itchiness, or they may be asymptomatic. Symptoms depend on the underlying cause of hair loss. Some may also complain of scarring madarosis.

There are various local or systemic(body-wide) causes of madarosis. Following are some of the causes of madarosis,

Infections

Many infections can cause hair loss or more specifically eyebrow loss or eyelash loss. Leprosy is a common cause of madarosis. Leprosy or Hansen’s disease is a bacterial infection that affects skin, eyes, nose, and nerves. 

Lepromatous leprosy includes hair loss from all over the body. It is common in many countries, however not very common in the United States. 

Syphilis, and other viral infections such as HIV and Herpes can also cause madarosis. Fungal infections caused by Microsporum, trichophyton, etc can also contribute to this condition. 

Trauma

Physical trauma to eyelashes or eyebrows can lead to hair loss. Trauma includes injury, burns, or wounds in or around the nearby area. 

Thyroid

Thyroid leads to loss of hair from eyebrows. The thyroid gland produces the thyroid hormone which regulates the metabolism of the body. When the body produces less thyroid hormone (hypothyroidism) or more amount of thyroid hormone (Hyperthyroidism) it affects the functioning of the body, including hair growth. 

Autoimmune diseases

Various autoimmune diseases such as discoid lupus erythematosus, chronic cutaneous lupus erythematosus, Parry Romberg syndrome, and Graham-Little syndrome also lead to loss of hair.

Alopecia Areata

Alopecia areata is an autoimmune disease. It targets hair follicles, slowing or completing halting the process of hair growth. It can either produce bald spots in the scalp or it can result in loss of all hair. Along with scalp hair, it affects eyelashes and eyebrows. It leads to scarring madarosis (irreversible damage). In such conditions, surgical treatments are the only available option. 

Chronic Blepharitis

Blepharitis is an infection of the eyelids. Symptoms include inflammation, dry eyes, itchy and red eyelids, and crust around the eyelids. It is chronic and causes madarosis. It decreases the quality of life if it is not managed well. 

Nutritional defects

The human body requires a proper balance of various nutrients. Some of these nutrients are essential for maintaining the length and volume of hair. Extreme malnutrition can cause severe hair loss. 

Deficiencies of zinc, telogen, biotin, cysteine, Vitamin C, E, B12, D, omega 3-fatty acids and iron can also contribute to hair loss. 

Trichotillomania

Trichotillomania is a mental health condition, in which the patient deliberately pulls out their hair. They commonly remove hair from eyelashes, eyebrows, and scalp.

Medications

Many drugs or medications also lead to hair loss. Chemotherapy drugs and cocaine lead to hair loss. Other drugs include,

• Epinephrine
• Antithyroid drugs
• Anticoagulants
• Anticonvulsants
• Retinoids
• Botulinum toxin
• MMR vaccine
• Propranolol
• Androgens

Genetic Conditions

Few genetic disorders that cause madarosis include Ectodermal dysplasia, Ehlers-Danlos syndrome, cryptophthalmos, and ichthyosiform erythroderma.

Dermatological Conditions

Atopic dermatitis (Eczema)

Atopic dermatitis is a chronic inflammatory disease of the skin. It causes redness, itchiness, and irritation. It develops in early childhood or in people who have a medical history. Since hair follicles are embedded in the skin, eczema can lead to madarosis. 

Psoriasis

Psoriasis is a chronic autoimmune disease. It causes red, itchy patches on the body. It causes cells to multiply very quickly and blocks the growth of hair follicles as well. 

Contact dermatitis

Contact dermatitis is caused when the skin comes in contact with an allergen. Patients experience a burning sensation. The inflammation blocks hair follicles and the growth of hair. 

Other dermatological conditions include frontal fibrosing alopecia, follicular mucinosis, acne rosacea, telogen effluvium, cutaneous sarcoidosis, and ulerythema ophryogenes can result in madarosis.

Skin Cancer

Madarosis is a symptom of skin cancer. Loss of eyelashes and eyebrows is common in malignant (cancerous) and benign (non-cancerous) cancers. 

Toxic neoplasms

Few toxins also induce madarosis in a person. These toxins include arsenic, gold, bismuth, quinine, mercury, thallium, and hypervitaminosis A 

Other diseases and conditions

• Gunter’s disease
• Scleroderma
• Hypoparathyroidism
• Hypopituitarism

Many diseases and conditions can cause madarosis as a symptom or side-effect.

Your doctor will examine the symptoms, inquire about your medical history, and do a physical examination. Additionally, tests may be required to diagnose underlying conditions. The following tests are useful in diagnoses of the disease,

• Blood tests
• Skin swab to check for bacterial infections
• Skin scraping to check for fungal infections
• Dermatoscopy to examine skin with a magnifier 

Establishing the diagnosis is important to differentiate between scarring and non-scarring madarosis. It also helps to determine whether the condition is due to disease, reaction, infection, or inheritance. 

Correct diagnosis is a prerequisite to provide proper treatment. Correct treatment can reverse madarosis if detected at an early stage. Permanent loss of hair cannot be reversed. There are multiple treatment options available to treat the condition.

Cosmetic Treatments

No one likes to with the loss of eyelashes and eyebrows. From cosmetic to surgical, there are treatments available.

Many people adopt aesthetic camouflage for eyelashes and eyebrows. Either the patient can use mascara, fake eyelashes, use a brow pencil to create false eyebrows, or tattooing eyebrows/eyelashes. 

Surgical methods

Surgical treatment is mandatory when the damage is severe. Madarosis caused by leprosy, alopecia areata results in permanent damage (scarring madarosis). Earlier doctors used nylon implants, however, they have a high risk of infection and are banned from many regions. 

Follicular or hair transplantation is popularly adopted by surgeons. In this procedure, hair samples are taken from a donor area such as the occipital or lower part of the parietal scalp. They are dissected into individual hair follicle units. Single hair follicle grafts are preferred for eyebrows.

Accurate placement of each unit is important for natural-looking eyebrows.

Eyelash grafting is an effective surgical treatment for restoring lost eyelashes. In this technique, a french eye needle is used to insert hair follicles into the eyelids. The needle is pulled through the margin for accurate placement of each hair follicle. After placement, the hair follicle can be trimmed to create eyelashes. 

Eyebrow grafting also has high success rates and normal eyebrows begin to grow after 3-4 months and fully grow by 6 months. 

Thus many surgical options are available to manage scarring madarosis in patients. 

Medications

There are a variety of topical solutions/serums for hair growth available in the market. Minoxidil solution is a topical treatment that can be used for hair growth in patients suffering from alopecia areata. Topic prostaglandin analogs are used for the treatment of glaucoma.  

Research suggests that using latanoprost in one eye, improved the growth of eyelashes. Bimatoprost ophthalmic solution was also safe (FDA-approved) and effective in inducing hair growth in patient’s eyelashes.  

Once your dermatologist has identified the proper cause of madarosis, there are many treatment options available to permanently treat the condition. 

If you are non-scarring madarosis, you may reserve hair growth and bring it back to normalcy. 

In case of scarring madarosis, various surgical and dermatological treatment options are available. Madarosis can indicate an underlying health issue, it is important to consult your doctor to identify the disease at an early stage. 

Dermatologists are the best specialists to treat any skin condition. However, fitting a dermatologist appointment into your schedule can be quite challenging. 

The pandemic has made in-person healthcare even riskier and for older patients who are suffering from a skin condition, any further delays will cause more damage.  

SkyMD has curated a virtual platform for all your skincare needs. The platform encompasses the country's best dermatologists who mainly prioritize their patients' well-being. 

Dermatologists are treating patients every day and have experience reviewing a broad range of cases all over the United States.

You will find board-certified dermatologists near you, who will begin with your online consultation and prescribe necessary medications, which you can avail of from your nearest pharmacy.

All you need to do is book an online consultation today!