Introduction

What’s Madarosis?

• Madarosis was first created to describe eyelash loss from damaged hair follicles, but now includes both eyelashes and eyebrows
• Not to be confused a Milphosis is the term used to describe the absence of eyelashes¹

Importance of Eyelashes and Eyebrows

• Eyelashes and eyebrows play distinct roles within the human body
• Eyelashes have an important role in safeguarding the eye area from external disruptions like sweat, microorganisms, debris, as well as light, water, and wind
• Madarosis can greatly affect the quality of life for those affected, as they may perceive a decrease in their physical attractiveness²

Overview of Endocrine Disorders

The endocrine system is highly intricate and impacts all bodily functions. In this chapter, we will focus on various established hormonal systems and common gene mutations linked to endocrine disorders.

The disorders affecting endocrine glands can be classified into three groups: 

• Overactivity
• Underactivity
• Growth

Due to the impact of endocrine diseases on the endocrine regulatory circuits, the situation can be complex with conflicting changes at various regulatory levels.³

Causes of Madarosis

Common Reasons for Madarosis Encompass

• Infection caused by Staphylococcus bacteria , Simplex herpes
• Rosacea is a skin condition Hair loss condition in which the immune system attacks hair follicles, leading to hair loss in patches
• Hypothyroidism commonly impacts the outer one-third of the eyebrow on both sides
• Eczema chronic skin condition characterized by red, scaly patches. Emotional distress.
• Drug Induce Madarosis chemotherapy, radiotherapy, laser treatment, and botulinum toxin injection

Less Common Causes 

• Cutaneous Lupus Erythematosus presenting as round or disk-shaped patches
• Systemic Sclerosis
• Lichen Planopilaris 
• Frontal Fibrosing Alopecia 
• Other forms of skin cancer including intraepidermal carcinoma, basal cell carcinoma, squamous cell carcinoma, and melanoma
• Infection-induced by conditions like ringworm, atypical mycobacteria, leprosy, and HIV
• Toxic levels of Vitamin A
• Adverse effects of drugs (such as thallium and cocaine)
• Genetic or inherited diseases like ichthyosiform erythroderma, ectodermal dysplasia, cryptophthalmos, and Ehlers-Danlos syndrome may be present
• Psychiatric factors such as trichotillomania and dermatitis a rtefacta can be the reasons for this⁴

Endocrine Disorders Associated with Madarosis

• Hypothyroidism
• Hyperthyroidism
• Diabetes Mellitus
• Other Endocrine Disorders 
  • Hypopituitarism: Reduced production of pituitary hormones affecting hair growth
  • Addison's Disease: Adrenal insufficiency leading to skin and hair changes
  • Cushing's Syndrome: Excess cortisol production resulting in brittle hair

Clinical Evaluation and Diagnosis

History Taking

Most cases of madarosis result from specific eyelid issues such as blepharitis, skin diseases, or localized tumors. Which Inquire specifically about skin, hormonal, cancerous, immune-related, and contagious illnesses. Causes may also include trauma, lack of nutrients, medications, and allergens. Having a family history is crucial in congenital situations. In the appropriate clinical setting, a psychosocial history could help confirm a diagnosis of trichotillomania.

Madarosis is a diagnosis made based on clinical evaluation. 

Physical Examination

During a close examination in the area, looking for:

• The degree of eyelash shedding (specific areas or spread out)
• The occurrence of eyelash or eyebrow hair growing back at varying speeds, or having fractured tips (indicative of trichotillomania diagnosis)
• Inflammation of the eyelids is known as blepharitis
• Injuries at the edge of the eyelash line
• Skin rash that is limited to a specific area
• Loss of eyebrow hair linked to
• During a comprehensive check, look for:
  • Signs of a skin condition
  • Hair loss linked together

Laboratory Tests

• Thyroid Function tests
• Blood Glucose levels
• Cortisol Levels

Imaging Studies

• Thyroid Ultrasound
• Pituitary MRI (if indicated)⁵

Management of Madarosis in Endocrine Disorders

• In severe cases of instances of Madarosis, surgery involves the transplantation of eyebrow hair follicles
• cuts are created and hair is transferred to the balding area. Stitches or cuts are not involved in the treatment, and the hair will start growing after a few months post-surgery
• Topical medicines like latanoprost and bimatoprost are  used to extend or thicken eyelash hair. Topical medications can also help make treating eyebrow hair loss easier
• Biotin supplements as known help to promote the growth of new hair and aid in restoring damaged hair texture
• Borax could be helpful in treating toxins and infections, promoting the growth of new hair⁶

Summary

Madarosis before describe is the absence of eyelashes due to damaged hair follicles, but it now encompasses both eyelashes and eyebrows. Frequently triggered by Staphylococcus bacteria infection, herpes simplex, rosacea, as well as an autoimmune disorder that targets hair follicles, leading to sporadic hair loss. Hypothyroidism commonly impacts the outer third of the eyebrows bilaterally. Madarosis is diagnosed by evaluating the clinical assessment. While surgery is an option, topical medication is the preferred choice.