Madarosis: Symptoms, Causes and Treatment

Madarosis—the medical term for the loss of eyebrows and/or eyelashes—is more than just a cosmetic concern. This striking sign can be a clue to a range of underlying health conditions, from localized skin disorders to complex systemic diseases. Understanding madarosis is crucial for both patients and clinicians, as it can indicate treatable or even serious underlying issues. In this article, we explore the symptoms, diverse causes, and evolving treatments for madarosis, combining the latest clinical insights with practical advice for those affected.

Symptoms of Madarosis

Madarosis presents in different forms and severities, depending on its root cause. Recognizing its features is the first step toward diagnosis and effective management. While eyebrow and eyelash loss can be distressing, understanding its patterns and associated signs can help guide a more accurate clinical evaluation.

Symptom	Description	Associated Features	Source(s)
Eyebrow loss	Partial or complete loss of eyebrow hair	May affect one or both sides; can be patchy or diffuse	1, 3, 7
Eyelash loss	Partial or complete loss of eyelash hair	May occur along with redness, scaling, pain	1, 5, 6
Scarring	Hair loss with scarring of follicles	Usually permanent, associated with skin changes	7
Non-scarring	Hair loss with preserved follicles	Often reversible with treatment	1, 7
Skin changes	Redness, scaling, plaques, or swelling	Often seen with dermatological causes	2, 6
Other signs	Broken, short hairs, crusting, exudates	Indicative of trichotillomania or infection	6

Table 1: Key Symptoms

Patterns of Hair Loss

Madarosis can affect the eyebrows, eyelashes, or both. The loss may be partial (involving parts of the brow or lash line) or complete. The lateral third of the eyebrow is particularly prone to thinning in certain diseases, while diffuse loss is seen in others. The hair loss can be symmetrical or affect only one side, which may hint at specific causes such as local tumors or trauma 1 4 7.

Scarring vs. Non-Scarring Madarosis

A key feature in evaluating madarosis is whether the hair loss is scarring or non-scarring:

• Scarring madarosis involves destruction of the hair follicle, often from chronic inflammatory or autoimmune processes. This type is usually permanent, with visible changes such as atrophy, scaling, or shiny skin 7.
• Non-scarring madarosis preserves the follicles, so hair regrowth is possible if the underlying cause is addressed. It is often associated with acute or reversible conditions, such as infections, drug reactions, or nutritional deficiencies 1 5 6 7.

Associated Skin and Ocular Findings

Madarosis often occurs with other local symptoms:

• Redness, scaling, and plaques: These suggest an underlying dermatological disorder, such as blepharitis or dermatitis 2 6.
• Pain or swelling: May accompany inflammatory or infectious causes 2 6.
• Crusting or exudates: Commonly seen in infective blepharitis 6.
• Short, broken hairs: Characteristic of trichotillomania (hair-pulling disorder) 6.

Clinical Clues

The pattern and associated features of madarosis can offer important diagnostic clues:

• Unilateral loss may point to local pathologies, including tumors or localized trauma 4.
• Loss of the lateral third of the eyebrows is classically seen in hypothyroidism and lymphatic drainage disorders 4.
• Associated systemic symptoms (fatigue, muscle pain, etc.) may suggest systemic or metabolic disease 2 5.

Causes of Madarosis

The causes of madarosis are remarkably diverse, spanning local skin diseases, systemic illnesses, drug reactions, and even rare genetic or metabolic disorders. Identifying the underlying cause is essential for effective treatment and can sometimes uncover serious health conditions.

Cause Type	Examples	Key Features/Notes	Source(s)
Dermatological	Blepharitis, dermatitis, psoriasis, trichotillomania	Localized symptoms, scaling, itching	3, 6, 7
Infectious	Leprosy, syphilis, fungi, parasites	May have crusting, exudates, or plaques	3, 5, 6
Endocrine/Metabolic	Hypothyroidism, hyperthyroidism, mitochondriopathy	Often with systemic symptoms, e.g., fatigue, atrophy	3, 5, 7
Autoimmune	Systemic lupus erythematosus, alopecia areata	May involve other organs, hair loss patterns	3, 7
Nutritional	Protein, zinc, biotin, ferritin deficiencies	Typically diffuse, non-scarring	3, 7
Drug-induced	Chemotherapy, retinoids, methylphenidate, ACE inhibitors, statins	Sudden onset after medication start/change	3, 8
Trauma/Surgery	Eyelid injury, surgical damage	Usually localized, scarring	10
Tumors/Neoplasia	Local tumors, paraneoplastic syndromes	Can cause scarring, unilateral loss	5, 7
Other	Lymphatic obstruction, radiotherapy, botulinum toxin	May cause lateral eyebrow loss, swelling	4, 5

Table 2: Principal Causes of Madarosis

Dermatological and Infectious Causes

• Blepharitis: A common cause of eyelash loss, blepharitis is inflammation of the eyelid margins. It can be infective (usually staphylococcal) or seborrheic, often presenting with crusting and exudates 6.
• Dermatitis: Both atopic and contact dermatitis, as well as seborrheic dermatitis, can cause eyebrow or eyelash loss when they involve the periocular skin 3 6.
• Psoriasis: May present with scaling and hair loss at the eyebrows 3.
• Trichotillomania: A behavioral disorder in which patients pull out their own lashes or brows, leading to irregular areas of loss and broken hairs 6.
• Infections: Leprosy is a classic cause, seen in up to 76% of cases, but syphilis, fungal infections, and parasitic infestations can also lead to madarosis 3 5 6.

Systemic, Autoimmune, and Metabolic Disorders

• Endocrine diseases: Both hyperthyroidism and hypothyroidism are well-recognized causes, often with loss of the lateral third of the eyebrow 3 7.
• Systemic lupus erythematosus (SLE): Can cause diffuse or patchy eyebrow and eyelash loss 3 7.
• Mitochondriopathies: Rare metabolic disorders can present with bilateral madarosis, especially when other common causes are excluded 5.
• Nutritional deficiencies: Protein, zinc, biotin, and ferritin deficiencies may lead to diffuse, reversible hair loss 3 7.

Drug-Induced and Iatrogenic Causes

A wide range of medications can cause madarosis as a side effect:

• Chemotherapy: Particularly common in cancer patients, causing both scalp and eyelash/eyebrow hair loss 8.
• Methylphenidate: Rarely associated with madarosis, especially in pediatric patients 3.
• Other drugs: Retinoids, antiepileptics, statins, ACE inhibitors, antithyroid agents, and others have all been implicated 3.
• Botulinum toxin: Has been reported to cause facial and eyebrow hair loss as an idiosyncratic reaction 4.

Trauma, Surgery, and Tumors

• Trauma: Injury or surgical damage to the eyelid can lead to localized, often scarring madarosis 10.
• Tumors: Both benign and malignant growths can destroy follicles or cause local inflammation and hair loss 5 7.
• Radiotherapy: Local irradiation can damage hair follicles 3.

Other and Rare Causes

• Lymphatic obstruction: Can cause loss of the lateral third of the eyebrow due to impaired drainage 4.
• Genetic syndromes: Rarely, madarosis is part of broader syndromic presentations 5.

Treatment of Madarosis

Treatment for madarosis depends on the underlying cause. While some cases are reversible with simple interventions, others require complex medical or surgical management. Advances in drug therapy and surgical techniques have improved outcomes and cosmetic satisfaction for many patients.

Treatment Type	Main Approaches/Examples	Suitability	Source(s)
Address underlying cause	Treat infections, correct deficiencies, stop offending drugs	Essential first step	1, 3, 5, 7
Topical therapy	Antibiotics, corticosteroids, bimatoprost gel	Dermatological/inflammatory, chemo-induced cases	2, 8
Systemic therapy	Immunosuppressants, JAK inhibitors	Autoimmune and refractory cases	7, 9
Hair restoration	Follicular unit transplantation, free hairy grafts	Scarring or traumatic madarosis	7, 10
Cosmetic solutions	Camouflage makeup, artificial lashes	Temporary or adjunctive	7

Table 3: Treatment Modalities for Madarosis

Treating the Underlying Cause

The cornerstone of madarosis management is identifying and treating its root cause:

• Infections: Topical or systemic antibiotics/antifungals are used for blepharitis or other infections 1 6.
• Dermatological inflammation: Topical corticosteroids or immunomodulators help reduce inflammation in cases such as dermatitis or psoriasis 1 7.
• Nutritional deficiencies: Supplementation with protein, zinc, biotin, or iron is crucial when deficiencies are identified 3 7.
• Endocrine disorders: Correcting thyroid imbalances or other hormonal issues can reverse hair loss 3 7.
• Drug-induced: Discontinuing or substituting the offending medication often leads to regrowth 3 8.

Topical and Systemic Therapies

• Bimatoprost eyelash gel: This prostaglandin analog has shown efficacy in enhancing eyelash growth in chemotherapy-induced madarosis, with significant improvements in length, thickness, and patient satisfaction 8.
• JAK inhibitors (e.g., ruxolitinib): These systemic agents, used for certain hematologic and autoimmune conditions, may incidentally stimulate eyelash and eyebrow growth—raising hope for new treatments in alopecia-associated madarosis 9.
• Immunosuppressants: For autoimmune causes, systemic therapy may be required to control the underlying disease and support hair regrowth 7.

Surgical and Hair Restoration Approaches

• Follicular unit transplantation: This surgical technique can be effective for scarring or permanent madarosis, particularly of the eyebrows and eyelashes. Hair is transplanted from other body areas to restore natural appearance 7.
• Free hairy grafts: For traumatic eyelid loss, grafting from eyebrows can reconstruct the lash line and restore function and appearance, though achieving optimal lash direction and thickness is technically challenging 10.

Cosmetic and Supportive Options

• Makeup and artificial lashes: Temporary cosmetic solutions may help patients cope with the psychosocial impact of madarosis, especially when regrowth is slow or incomplete 7.
• Counseling: Psychological support is often valuable, particularly in cases with visible or distressing hair loss.

Conclusion

Madarosis, the loss of eyebrows and/or eyelashes, is a visible sign with many potential causes requiring careful evaluation and tailored management. Understanding its patterns, associated features, and underlying causes is essential for effective treatment and improved patient outcomes.

Key Points:

• Madarosis can be partial or complete, scarring or non-scarring, and is often accompanied by other skin or ocular changes.
• Causes range from local skin disease and infection to systemic conditions, drug reactions, trauma, and rare metabolic or genetic syndromes.
• Treatment focuses on addressing the underlying cause, with options including topical/systemic medications, advanced hair restoration techniques, and cosmetic support.
• New therapies, such as bimatoprost gel and JAK inhibitors, show promise for challenging cases.
• Multidisciplinary care and psychological support are vital for optimal management and patient well-being.

By recognizing madarosis as more than just a cosmetic issue, clinicians and patients can work together to uncover and address the root causes, restoring both health and confidence.