Madarosis

Madarosis
Madarosis
Specialty	Dermatology, ophthalmology, optometry

Last updated December 12, 2023

Madarosis is a condition that results in the loss of eyelashes, and sometimes eyebrows. The term "madarosis" is derived from the ancient Greek "madaros", meaning "bald".^[1] It originally was a disease of only losing eyelashes but it currently is the loss of both eyelashes and eyebrows. Eyebrows and eyelashes are both important in the prevention of bacteria and other foreign objects from entering the eye. A majority of patients with madarosis have leprosy, and it was reported that 76% of patients with varying types of leprosy had madarosis.^[2]

Signs and symptoms

Madarosis is not a critical or severe condition. The main symptom and sign of madarosis is the loss of hair from the eyelids, eyebrows, or eyelashes. Many symptoms are from other diseases involved.

Swollen, itchy, red, burning eyelids
Loss of hair from other parts of the body, mainly the scalp
Weight gain or palpitation if there is a thyroid problem

Causes

There are various causes of madarosis.^[3]

Ophthalmological conditions: blepharitis is an infection of the eyelid. Anterior blepharitis is either staphylococcal blepharitis, or seborrhoeic blepharitis and posterior blepharitis is due to the meibomian gland.
Dermatologic conditions: there are multiple types of dermatological conditions that can result in madarosis. These include atopic dermatitis, seborrhoeic dermatitis atopic dermatitis, and psoriasis on the eyelids can result in madarosis. Others include: frontal fibrosing alopecia, ulerythema ophryogenes, acne rosacea, telogen effluvium, follicular mucinosis, and cutaneous sarcoidosis.
Nutritional defects: Severe malnutrition can cause chronic hair loss. Hypoproteinemia causes hair loss by early onset of telogen. Zinc deficiencies like acrodermatitis enteropathica, can lead to the loss of eyebrow/eyelash hair. Other deficiencies like biotin and iron make it possible for loss of hair as well.
Infections: There are many bodily infections that can cause the loss of eyelashes/eyebrows. The most common infection may be leprosy, such as lepromatous leprosy.^[4] Syphilis or other viral infections like herpes or HIV can cause the loss of eye hair as well. Fungal infections, like paracoccidioidomycosis, trichophyton, or microsporum, are also possible infection causes.
Trauma: Most trauma injuries cause madarosis from the psychological standpoint, known as trichotillomania
Drugs/Medications: Crack cocaine or chemotherapy drugs. Other drugs include:propranolol, valproic acid, barbiturates, MMR vaccine, botulinum toxin, epinephrine, antithyroid drugs, anticoagulants, and lipid-lowering drugs
Genetics
Autoimmune disorders: alopecia areata, discoid lupus erythematosus, chronic cutaneous lupus erythmatosus, Graham-Little syndrome, and Parry Romberg syndrome
Other diseases: hypothyroidism, hyperthyroidism, hypoparathyroidism, hypopituitarism, amyloidosis, and Congenital erythropoietic Porphyria ^[5] (Günther's disease)

Pathophysiology

There are two major pathways. In the non-scarring pathway, the hair follicles remain intact which could potentially be reversed with the proper diagnosis and treatments.^[6] In the scarring pathway, the follicles are permanently lost due to tissue damage, atrophy, or inflammation.^[7]

The severity of the pre-existing condition determines which type of madarosis occurs.

Ophthalmologic conditions: there are multiple types of infections and are common. The gray line of the eye is a line that divides the eyelid into parts: anterior part is skin and muscle while posterior is tarsus and conjunctiva. The blepharitis is classified based on the type of eyelid involvement. Anterior blepharitis is either staphylococcal blepharitis, or seborrhoeic blepharitis which have symptoms of the presence of scales that are along the hair shaft. Posterior blepharitis is usually due to meibomian gland dysfunction.
Dermatologic conditions: there are multiple types of dermatological conditions that can result in madarosis dependent on the location. Atopic dermatitis is associated with allergic disorders and affects the lower eyelid. Seborrhoeic dermatitis can be seen as the scaling of the eyebrows. Loss of eyebrows is commonly seen from both atopic and seborrhoeic dermatitis due to continuous scratching/touching. Psoriasis on the eyelids can result in madarosis. Others include: frontal fibrosing alopecia, ulerythema ophryogenes, acne rosacea, telogen effluvium, follicular mucinosis, and cutaneous sarcoidosis.
Nutritional Defects: Zinc is important in hair growth and the lack of zinc can cause hair loss, specifically madarosis. The main proteins in hair are biotin and iron so deficiencies would result in a loss of hair.
Infections: Unilateral madarosis (only one eye) may occur in tuberculoid leprosy from granulomatous infiltration of hair follicles ultimately destroying them. Infections like syphilis by causing a moth-eaten appearance of the eyebrow hair loss. Viral infections like herpes or HIV can cause scarring of the eyelid, causing loss of hair. Various fungal infections like paracoccidioidomycosis can cause lesions and changes in the hair locations of the eyelid.
Trauma: Trichotillomania is a psychological disorder where the hair is pulled out or breakage occurs when anxious. Both trichoteiromania (hair loss from constant rubbing) and trichotemnomania (hair loss from constant shaving of the hair) can result in hair loss.
Drugs/Medications: The heart medication amiodarone has been reported to commonly cause loss of eyelashes and eyebrows. Cocaine abuse has shown hair loss due to the hot vapors traveling up causing burning of the hair of the eyebrows or eyelashes. Radiotherapy and chemotherapy can cause hair loss due to the eradication of the hair cells, especially when used to treat ocular tumors.
Genetics: Some of the diseases listed in the causes can be inherited.

Diagnosis

The main diagnosis technique is observing the area. Then blood tests can be done to determine if there is a pre-existing condition. Family history can be considered because some of the related causes/conditions can be inherited.

Classifications

There are two major types of classifications of madarosis. The first is labeled as "non-scarring." Non-scarring the hair has the ability to regrowth after treatment of the primary disorder. Scarring madarosis is when the hair loss is permanent and can only regrow after cosmetic treatments.^[8]

Prevention

The only prevention method is determining the underlying condition before treatment options are too late.^{[ citation needed ]}

Treatments

Madarosis has different possible treatments and can be reversed if treated early enough. The treatments for madarosis are completely dependent upon the pre-existing condition. When treating blepharitis, antibiotics are used to combat the bacterial infection. People with trichotillomania need to seek behavioral and psychological help.^{[ citation needed ]} Many people look to hair transplant surgeries, especially in non-scarring cases. These surgeries are mainly used as a cosmetic reason rather than a medical one. There are also other treatments that can be used for cosmetic purposes.

Surgical treatments

There are restoration surgeries for the eyebrows in severe cases. Many surgeons opt for nylon implants, but have been banned in some countries due to infections. Follicular transplantation is now the procedure of choice. In this surgery, hair samples are individually taken for a donor area and transplanted into the thinning area. Small incisions are made and grafts are placed individually according to the amount of hair in each follicle, eyebrows single. In this procedure, there are no scars or stitches and hair begins to grow after a few months post surgery.^[9]

Medications

Minoxidil is a common topical treatment of eyebrow hair loss due to alopecia areata. There are other topical treatments (latanprost or bimatroprost) that are mainly used to treat glaucoma that can also be used to lengthen, thicken, and change the pigments of the lashes.^[10]

Cosmetic treatments

Many people use cosmetic treatments to cover the loss of the hair, such as applying artificial eyelashes, tattooing eyebrows/eyelashes, penciling in the eyebrows or using mascara to make the existing eyelashes look longer. Some people even use eyeliner to make the eye stand out when lacking eyelashes.

Recent research

There is currently researching being done to find more treatments dependent on the different pre-existing conditions.

Studies are being conducted in which madarosis can be related to malignancy. A study by Groehler and Rose found that there was a statistical significance between these two. They concluded that patients malignancy lesions on the eyelid have a higher chance of having madarosis than a patient with a benign lesion. They stated that despite the fact that it is significant, the absence of madarosis does not mean the lesion cannot be malignant.^[11]

In many leprosy cases, madarosis is a symptom or a quality after diagnosis. However, in India, leprosy is common and researchers report a case of madarosis before diagnosis of leprosy with no skin lesions, only madarosis. This allowed for quicker treatment.^[12]

The main reason many people have madarosis is due to the chemotherapy drugs. There was a clinical trial in 2011 that tested an eyelash gel called bimatoprost. This gel enhanced the eyelashes in quantity and thickness. They tested this on 20 breast cancer patients who were undergoing chemotherapy. Results seemed positive, in that the group of people who used the gel had growth of eyelashes after the chemotherapy drugs.^[13]

Related Research Articles

<span class="mw-page-title-main">Hair loss</span> Loss of hair from the head or body

Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scarring is not usually present. Hair loss in some people causes psychological distress.

Blepharitis, sometimes known as "granulated eyelids," is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause swelling, burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis by itself is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The primary cause is bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.

An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. "Palpebral" means relating to the eyelids. Its key function is to regularly spread the tears and other secretions on the eye surface to keep it moist, since the cornea must be continuously moist. They keep the eyes from drying out when asleep. Moreover, the blink reflex protects the eye from foreign bodies. A set of specialized hairs known as lashes grow from the upper and lower eyelid margins to further protect the eye from dust and debris.

An eyelash is one of the hairs that grows at the edges of the top and bottom eyelids, spanning outwards and away from the eye. The lashes grow in up to six layers on each of the upper and lower eyelids. Eyelashes serve to protect the eye from debris, dust, and small particles, and are highly sensitive to touch, thus providing a warning that an object is near the eye. The eyelid margin from which lashes grow is among the most sensitive parts of the human body, with many nerve endings enveloping the roots of the lashes, giving it sensitivity to very light tactile input via the lashes, enabling it to trigger the blink reflex when touched. Eyelashes are also an important component of physical attractiveness, with prominent lashes drawing attention to the eyes.

<span class="mw-page-title-main">Alopecia universalis</span> Medical condition

Alopecia universalis(AU), also known as alopecia areata universalis, is a medical condition involving the loss of all body hair, including eyebrows, eyelashes, chest hair, armpit hair, and pubic hair. It is the most severe form of alopecia areata. People with the disease are usually healthy and have no other symptoms and a normal life expectancy.

<span class="mw-page-title-main">Vellus hair</span> Type of hair that is short, thin, slight-colored, and barely noticeable

Vellus hair is short, thin, light-colored, and barely noticeable hair that develops on most of a human’s body during childhood. Exceptions include the lips, the back of the ear, the palm of the hand, the sole of the foot, some external genital areas, the navel, and scar tissue. The density of hair – the number of hair follicles per area of skin – varies from person to person. Each strand of vellus hair is usually less than 2 mm long and the follicle is not connected to a sebaceous gland.

The Hamilton–Norwood scale is used to classify the stages of male pattern baldness. It is one of the widely accepted and reproducible classification system for the male pattern hair loss. The stages are described with a number from 1 to 7 with a type A variant for the cases with anterior involvement.

The management of hair loss, includes prevention and treatment of alopecia, baldness, and hair thinning, and regrowth of hair.

Cradle cap causes crusty or oily scaly patches on a baby's scalp. The condition is not painful or itchy, but it can cause thick white or yellow scales that are not easy to remove. Cradle cap most commonly begins sometime in the first three months but can occur in later years. Similar symptoms in older children are more likely to be dandruff than cradle cap. The rash is often prominent around the ear, the eyebrows or the eyelids. It may appear in other locations as well, where it is called infantile seborrhoeic dermatitis. Cradle cap is just a special—and more benign—case of this condition. The exact cause of cradle cap is not known. Cradle cap is not spread from person to person (contagious). It is also not caused by poor hygiene. It is not an allergy, and it is not dangerous. Cradle cap often lasts a few months. In some children, the condition can last until age 2 or 3.

Trichology is the study of the hair and scalp. The term derives from Ancient Greek θρίξ (thríx), "hair" and -λογία -logia. In most jurisdictions the title of a trichologist, not the field of trichology, is considered a para-medical discipline.

<span class="mw-page-title-main">Hair transplantation</span> Surgical operation to relocate hair follicles

Hair transplantation is a surgical technique that removes hair follicles from one part of the body, called the 'donor site', to a bald or balding part of the body known as the 'recipient site'. The technique is primarily used to treat male pattern baldness. In this minimally invasive procedure, grafts containing hair follicles that are genetically resistant to balding are transplanted to the bald scalp.

Anagen effluvium is the pathologic loss of anagen or growth-phase hairs. Classically, it is caused by radiation therapy to the head and systemic chemotherapy, especially with alkylating agents.

Pityriasis amiantacea is an eczematous condition of the scalp in which thick tenaciously adherent scale infiltrates and surrounds the base of a group of scalp hairs. It does not result in scarring or alopecia.

Non scarring hair loss, also known as noncicatricial alopecia is the loss of hair without any scarring being present. There is typically little inflammation and irritation, but hair loss is significant. This is in contrast to scarring hair loss during which hair follicles are replaced with scar tissue as a result of inflammation. Hair loss may be spread throughout the scalp (diffuse) or at certain spots (focal). The loss may be sudden or gradual with accompanying stress.

Triangular alopecia is hair loss that may be congenital but usually appears in childhood as a focal patch of loss that may be complete or leaving fine vellus hairs behind. Affected individuals are typically entirely healthy. Hair restoration surgery using follicular unit transplantation has been a successful treatment modality for TTA

Frontal fibrosing alopecia is the frontotemporal hairline recession and eyebrow loss in postmenopausal women that is associated with perifollicular erythema, especially along the hairline. It is considered to be a clinical variant of lichen planopilaris.

Canities subita, also called Marie Antoinette syndrome or Thomas More syndrome, is an alleged condition of hair turning white overnight due to stress or trauma. The trivial names come from specific cases in history including that of Queen Marie Antoinette of France whose hair was noted as having turned stark white overnight after her capture following the ill-fated flight to Varennes during the French Revolution. An older case of Sir Thomas More's hair turning white the night before his beheading has also been recorded. Although a number of cases of rapid hair greying have been documented, the underlying patho-physiological changes have not been sufficiently studied.

Trichomegaly is a condition in which the eyelashes are abnormally long, objectively defined as 12mm or greater in the central area and 8mm in the peripheral. The term was first used by H. Gray in 1944 in a publication in the Stanford Medical Bulletin, though he was only the third person to characterize the disorder; the first two reports were published in German in 1926 and 1931 by Reiter and Bab, respectively. Gray suggested the use of the term "movie lashes" to describe this condition, for long lashes were at the time being portrayed in film as a desirable characteristic in women.

Collagen induction therapy (CIT), also known as microneedling, dermarolling, or skin needling, is a cosmetic procedure that involves repeatedly puncturing the skin with tiny, sterile needles. CIT should be separated from other contexts in which microneedling devices are used on the skin.

Frictional alopecia is the loss of hair that is caused by rubbing of the hair, follicles, or skin around the follicle. The most typical example of this is the loss of ankle hair among people who wear socks constantly for years. The hair may not grow back even years after the source of friction has ended.

References

↑ "Bioline International Official Site (site up-dated regularly)". www.bioline.org.br. Retrieved 2015-11-04.
↑ Krishnan, Ajay; Kar, Sumit (2012-01-01). "Bilateral Madarosis as the Solitary Presenting Feature of Multibacillary Leprosy". International Journal of Trichology. 4 (3): 179–180. doi: 10.4103/0974-7753.100092 . ISSN 0974-7753. PMC 3500062 . PMID 23180932.
↑ Kumar, Annapurna; Karthikeyan, Kaliaperumal (2012-01-01). "Madarosis: A Marker of Many Maladies". International Journal of Trichology. 4 (1): 3–18. doi: 10.4103/0974-7753.96079 . ISSN 0974-7753. PMC 3358936 . PMID 22628984.
↑ Parrino, D.; Di Bella, S. (2016). "Hertoghe sign: a hallmark of lepromatous leprosy". QJM. 109 (7): 497. doi: 10.1093/qjmed/hcw046 . ISSN 1460-2725.
↑ Feldman, Mark; Friedman, Lawrence S.; Brandt, Lawrence J. (2015-01-01). Sleisenger and Fordtran's Gastrointestinal and Liver Disease E-Book: Pathophysiology, Diagnosis, Management. Elsevier Health Sciences. ISBN 9781455749898.
↑ Khong, J. J.; Casson, R. J.; Huilgol, S. C.; Selva, D. (2006-11-01). "Madarosis". Survey of Ophthalmology. 51 (6): 550–560. doi:10.1016/j.survophthal.2006.08.004. PMID 17134645.
↑ Faheem, Mahmood Syed. "Madarosis - Loss of eyelashes - Loss of eyebrows | the dynamic natural skin care". Madarosis - Loss of eyelashes - Loss of eyebrows | the dynamic natural skin care. Retrieved 2015-12-10.
↑ Faheem, Mahmood Syed. "Madarosis - Loss of eyelashes - Loss of eyebrows | the dynamic natural skin care". Madarosis - Loss of eyelashes - Loss of eyebrows | the dynamic natural skin care. Retrieved 2015-12-10.
↑ "Follicular Unit Extraction (FUE) Hair Transplant | Bosley". www.bosley.com. Retrieved 2015-11-04. "Eyebrow Transplant Through Follicular Unit Transplant (FUT) | Medispa". www.medispaindia.in. Retrieved 2018-02-10.
↑ Kumar, Annapurna; Karthikeyan, Kaliaperumal (2012-01-01). "Madarosis: A Marker of Many Maladies". International Journal of Trichology. 4 (1): 3–18. doi: 10.4103/0974-7753.96079 . ISSN 0974-7753. PMC 3358936 . PMID 22628984.
↑ Groehler, Jennifer M.; Rose, John G. (2012-03-01). "Madarosis as an indicator for malignancy in eyelid margin lesions". Optometry and Vision Science. 89 (3): 350–352. doi:10.1097/OPX.0b013e31824352b6. ISSN 1538-9235. PMID 22246332. S2CID 52856613.
↑ Krishnan, Ajay; Kar, Sumit (2012-01-01). "Bilateral Madarosis as the Solitary Presenting Feature of Multibacillary Leprosy". International Journal of Trichology. 4 (3): 179–180. doi: 10.4103/0974-7753.100092 . ISSN 0974-7753. PMC 3500062 . PMID 23180932.
↑ Morris, Carrie L; Stinnett, SS; Woodward, JA (2011-01-01). "The Role of Bimatoprost Eyelash Gel in Chemotherapy-induced Madarosis: An Analysis of Efficacy and Safety". International Journal of Trichology. 3 (2): 84–91. doi: 10.4103/0974-7753.90809 . ISSN 0974-7753. PMC 3250027 . PMID 22223967.

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[1] "Bioline International Official Site (site up-dated regularly)". www.bioline.org.br. Retrieved 2015-11-04.

[2] Krishnan, Ajay; Kar, Sumit (2012-01-01). "Bilateral Madarosis as the Solitary Presenting Feature of Multibacillary Leprosy". International Journal of Trichology. 4 (3): 179–180. doi: 10.4103/0974-7753.100092 . ISSN 0974-7753. PMC 3500062 . PMID 23180932.

[3] Kumar, Annapurna; Karthikeyan, Kaliaperumal (2012-01-01). "Madarosis: A Marker of Many Maladies". International Journal of Trichology. 4 (1): 3–18. doi: 10.4103/0974-7753.96079 . ISSN 0974-7753. PMC 3358936 . PMID 22628984.

[4] Parrino, D.; Di Bella, S. (2016). "Hertoghe sign: a hallmark of lepromatous leprosy". QJM. 109 (7): 497. doi: 10.1093/qjmed/hcw046 . ISSN 1460-2725.

[5] Feldman, Mark; Friedman, Lawrence S.; Brandt, Lawrence J. (2015-01-01). Sleisenger and Fordtran's Gastrointestinal and Liver Disease E-Book: Pathophysiology, Diagnosis, Management. Elsevier Health Sciences. ISBN 9781455749898.

[6] Khong, J. J.; Casson, R. J.; Huilgol, S. C.; Selva, D. (2006-11-01). "Madarosis". Survey of Ophthalmology. 51 (6): 550–560. doi:10.1016/j.survophthal.2006.08.004. PMID 17134645.

[7] Faheem, Mahmood Syed. "Madarosis - Loss of eyelashes - Loss of eyebrows | the dynamic natural skin care". Madarosis - Loss of eyelashes - Loss of eyebrows | the dynamic natural skin care. Retrieved 2015-12-10.

[8] Faheem, Mahmood Syed. "Madarosis - Loss of eyelashes - Loss of eyebrows | the dynamic natural skin care". Madarosis - Loss of eyelashes - Loss of eyebrows | the dynamic natural skin care. Retrieved 2015-12-10.

[9] "Follicular Unit Extraction (FUE) Hair Transplant | Bosley". www.bosley.com. Retrieved 2015-11-04. "Eyebrow Transplant Through Follicular Unit Transplant (FUT) | Medispa". www.medispaindia.in. Retrieved 2018-02-10.

[10] Kumar, Annapurna; Karthikeyan, Kaliaperumal (2012-01-01). "Madarosis: A Marker of Many Maladies". International Journal of Trichology. 4 (1): 3–18. doi: 10.4103/0974-7753.96079 . ISSN 0974-7753. PMC 3358936 . PMID 22628984.

[11] Groehler, Jennifer M.; Rose, John G. (2012-03-01). "Madarosis as an indicator for malignancy in eyelid margin lesions". Optometry and Vision Science. 89 (3): 350–352. doi:10.1097/OPX.0b013e31824352b6. ISSN 1538-9235. PMID 22246332. S2CID 52856613.

[12] Krishnan, Ajay; Kar, Sumit (2012-01-01). "Bilateral Madarosis as the Solitary Presenting Feature of Multibacillary Leprosy". International Journal of Trichology. 4 (3): 179–180. doi: 10.4103/0974-7753.100092 . ISSN 0974-7753. PMC 3500062 . PMID 23180932.

[13] Morris, Carrie L; Stinnett, SS; Woodward, JA (2011-01-01). "The Role of Bimatoprost Eyelash Gel in Chemotherapy-induced Madarosis: An Analysis of Efficacy and Safety". International Journal of Trichology. 3 (2): 84–91. doi: 10.4103/0974-7753.90809 . ISSN 0974-7753. PMC 3250027 . PMID 22223967.

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