Madarosis is the loss of eyebrows and eyelashes caused by the destruction of hair follicles. The clinical picture is determined by the underlying disease. The most frequent concomitant manifestations: itching, burning. To make a diagnosis, visual examination, biomicroscopy, skin biopsy, microscopy of samples and laboratory tests are performed. Conservative therapy is reduced to the use of drugs based on minoxidil, prostaglandins and corticosteroids. Surgical treatment is aimed at transplantation of follicles, follicular blocks or skin flap. Alternative methods are represented by permanent makeup, eyelash extensions.
H02.7 Other degenerative diseases of the eyelid and ocular region
Madarosis is a pathology accompanied by a limited or complete absence of eyelashes and eyebrows. According to statistics, the disease develops in 12.6% of patients receiving chemotherapy. Women get sick 2.4 times more often than men, which is associated with a lower content of androgens in the blood and the widespread use of low-quality cosmetics. The disorder occurs at any age, but the first signs are more often diagnosed after 50 years. It is characterized by ubiquity.
Causes of madarosis
Many etiological factors leading to impaired growth of eyelashes and eyebrows are described. Madarosis may be a consequence of local changes or systemic pathologies. Leading causes of the disorder:
- Injuries. In the area of traumatic injuries, keloid scars may form, on the surface of which there is no hair. Similar deviations occur with burns. The lesion of the hair follicles is noted in obsessive-compulsive neurosis (trichotillomania, trichoteiromania, trichotemnomania).
- Blepharitis. The loss of eyelashes is caused by chronic inflammation of the eyelids, accompanied by periods of remissions and exacerbations. Often, staphylococcal blepharitis is observed in rosacea. Trachoma is a rarer cause, but it leads to irreversible consequences.
- Dermatological diseases. Madarosis occurs as a result of a number of skin diseases, which are manifested by itching and dryness. The most common among them are: atopic dermatitis, seborrhea, ichthyosis. In women over 50 years of age, the main cause is postmenopausal frontal fibrosing alopecia.
- Taking medications. Long-term intake of heparin, anticonvulsants, androgens has a direct effect on hair growth. Generalized hairline changes occur with the use of chemotherapeutic agents.
- Intoxication. Poisoning with thallium and mercury leads to focal alopecia, dysfunction of the nervous system and gastrointestinal tract. With hypervitaminosis, retinoids act toxically on the skin and its appendages.
- Neoplasms. Hair regrowth is difficult with malignant tumors: sclerosing cancer of the sweat glands, basal cell and squamous cell cancers. Madarosis occurs with systemic mastocytosis and T-cell lymphoma of the skin.
- Endocrine diseases. Hair follicles are affected in response to thyroid dysfunction. With hypo- and hyperthyroidism, hair growth is disrupted at the cellular level, so the entire hairline suffers.
- Nutritional deficiency. The disease occurs with nutritional deficiency, manifested by hypoproteinemia and deficiency of vitamins and trace elements (zinc, iron, vitamin B7).
The mechanism of development of madarosis depends on the etiology. With seborrheic inflammation, fatty crusts form along the hair shaft. Staphylococcal infection leads to the appearance of hard fibrous scales covering the core of the eyelash. Due to inflammation of the edges of the eyelid and folliculitis, the hair bulb is destroyed. Posterior blepharitis is accompanied by dysfunction of the meibomian glands and secondary lesion of the palpebral margin.
With ichthyosis, psoriasis and atopic dermatitis, trophic disorders are noted. Burning and itching lead to constant scratching. Due to the accompanying dryness of the skin and brittle hair, madarosis is soon diagnosed. The pathogenesis of postmenopausal frontal fibrosing alopecia remains not fully understood. Erythema that has appeared along the hairline is replaced by scarring defects.
Thyroid hormone receptors are found in the epithelial and dermal layers adjacent to the follicles. Normally, triiodothyronine and thyroxine protect the hair bulb from apoptosis. Hypothyroidism is associated with generalized hair loss. With hyperthyroidism, the eyebrows become sharply thinner and break off. Similar changes can be traced in hypopituitarism.
There are congenital and acquired variants of the disorder. Congenital madarosis is a secondarily inherited trait, the underlying disease remains genetically determined. Hair or eyebrow loss may be partial or complete. Pathology develops in isolation or combined with alopecia. From a clinical point of view , the following forms of madarosis are distinguished in trichology:
- Brow. In this variant, the outer third of the eyebrow is often affected, which indicates a hormonal imbalance or atopic dermatitis. The loss of eyebrows is preceded by their thinning and fragility, dry skin. Sudden hair loss occurs with acute poisoning.
- Ciliated. In most cases, the costal edge of the upper eyelid is involved in the pathological process. The eyelashes of the lower eyelid are thinner, but their structure is restored faster. Regeneration is most difficult in the middle part of the upper eyelids.
The pathology is characterized by a bilateral lesion. The exception is post-traumatic madarosis. With blepharitis and skin diseases, there are complaints about the appearance of dry crusts, itching and burning. The periorbital area looks hyperemic and slightly edematous. Eyelashes and eyebrows are absent in the places of greatest friction (the outer part of the eyebrows, eyelashes of the upper eyelid).
Madarosis in patients with atopic dermatitis is accompanied by a predominant change in the eyelashes of the lower eyelid. The subglacial line is visualized due to edema of the eyelids (Denny-Morgan fold). A typical sign is the loss of the lateral third of the eyebrows (symptoms of Hertoge). In endocrine disorders, subtotal alopecia is combined with the brow type.
Taking medications leads to slowly progressive hair loss. The process is generalized. The hairline is restored only after the treatment is completed and the drug is completely removed from the body. Madarosis on the background of intoxication develops for 1-2 days. The affected follicles do not restore the lost functions.
The formation of dense keloid scars in the brow area and on the eyelids is a frequent outcome of the disease of inflammatory origin. With staphylococcal nature, madarosis is complicated by sycosis. In severe cases, the pathological process spreads to the conjunctiva and cornea, which leads to their inflammation. There is a high risk of chronic folliculitis. Symptoms of pyoderma are more likely to occur in systemic diseases. In atopic dermatitis, madarosis is accompanied by swelling of the periorbital region.
A detailed examination of the patient by a dermatologist allows you to determine most of the causes of the disease. When collecting anamnesis, it should be found out whether madarosis is isolated or combined with diffuse hair damage. It is necessary to clarify what the patient’s usual diet includes. It is important to pay attention to what daily care products and cosmetics are used. Basic diagnostic methods:
- Microscopic examination. The condition of the fallen eyelashes is studied in detail. With hypo- or hyperthyroidism, the hair is thinned and brittle. Focal alopecia is manifested by proximal depigmentation, a pointed root and a thickened distal end. With trichotomy, fragments of hairs are found.
- Skin biopsy. With focal alopecia, a chronic focus of lymphocytic infiltration around the hair follicle is determined in the biopsy. The study is carried out with chronic progressive blepharitis and inflammation of the meibomian glands to exclude sebaceous carcinoma.
- Laboratory tests. With atopic dermatitis, the level of immunoglobulin E in the blood increases. Thyroid dysfunction is accompanied by a violation of the synthesis of triiodothyronine and thyroxine. It is important to assess the content of zinc, iron and vitamin B7 in the blood.
- Biomicroscopy. The study is performed by an ophthalmologist using a slit lamp. If the cause of madarosis is blepharitis, then dry scales are detected along the edge of the eyelid. They can envelop the hair shaft in the form of a “sleeve”, shift as they grow, or be single. Minor edema and hyperemia are visualized.
Therapeutic tactics are primarily aimed at eliminating the underlying disease. With fibrosing alopecia, the reception of funds, which include minoxidil, is indicated. The hair begins to grow back after 3 months, their growth reaches its peak after 12 months of use. The growth of eyelashes stimulates the local use of prostaglandins. However, when the product hits the surface of the eye, intraocular pressure decreases.
If replacement therapy for hyper- or hypothyroidism does not lead to spontaneous growth of eyelashes, then it is recommended to inject corticosteroids into the lesion with a short course. The alternative is hormonal ointments. If there is no effect and there are contraindications to the operation, eyebrow and eyelash tattooing, artificial eyelash extensions are performed.
For cosmetic purposes, hair follicle transplantation is performed. Due to the high degree of graft processing, the result is less noticeable on the eyelashes than on the eyebrows. Indications for surgery: ineffectiveness of drug therapy, partial or uneven regrowth of eyebrows and eyelashes.
With complete madarosis, it is possible to transplant a follicular block or a narrow flap of skin into the eyebrow area. If necessary, the seams are masked by trichopigmentation. The operation is indicated for scarring of the eyebrows, resistant to medication alopecia. After surgery, the hair begins to grow in 3-4 months, completely restores its structure in six months.
Prognosis and prevention
The outcome is determined by the underlying pathology. With a progressive increase in the size of the scar, there is no independent regression, and conservative therapy does not have the desired effect. However, madarosis lends itself to surgical methods of correction even with the formation of keloid scars. The prognosis for life and working capacity is favorable. No specific preventive measures have been developed. Non-specific prevention is aimed at the use of protective glasses and special masks when working with fire, wood or metal.
- Madarosis: A Marker of Many Maladies/ К. Kumar, K. Karthikeyan// International Journal of Trichology. – №4. – 2012. link
- Madarosis/ J.J. Khong, R.J. Casson, S.C. Huilgol, D. Selva// Survey of Ophthalmology. – №51. – 2006. link
- Madarosis: A dermatological marker/ S. Sachdeva, P. Prasher// Indian Journal of Dermatology, Venerology and Leprology. – №74. – 2008. link