Introduction

Madarosis is a condition whereby someone may lose the hair on their eyebrows or eyelashes. The loss may be partial or complete depending on the condition. There are many causes of madarosis including autoimmune diseases, dermatologic conditions, or an infection, either bacterial, viral, parasitic, or fungal.¹

Importance of eyebrows and eyelashes

Although it is not a life-threatening condition, madarosis may cause discomfort as well as self-esteem issues. The eyebrows are key in keeping sweat and any other debris from trickling down into the eye socket, which could otherwise be problematic. Sweat may contain chemicals that may be irritating to the eyes and could also pick up both dirt and microbes when trickling down the forehead, increasing the chance of eye infection. Eyebrows play a vital role in the communication of feelings, which is important for humans who are social by nature. Eyelashes are also important in keeping dust and dirt out of the eyes to prevent any vision obstruction, injury, or infection. Finally, both eyebrows and eyelashes play a crucial role in human aesthetic features and so their lack may cause people to feel less confident in themselves or maybe even slightly embarrassed.² 

Fungal infections

Fungal infections, also known as mycosis, are caused by eukaryotic (containing a membrane-bound nucleus like human cells) organisms that may be moulds or yeasts. Fungi are saprophytes, meaning they break down organic matter. Hence, they cause disease by breaking down human tissue. Fungi that cause madarosis tend to be dermatophytes, which require keratin, and so cause infection of the hair, skin, and nails. Fungi, which are likely to cause madarosis include Trichophyton, which is a dermatophyte, and Paracoccidioides, which is a dimorphic fungus (can exist as both a mould and yeast). 

Connection between madarosis and fungal infections

Fungal infections as a cause of madarosis 

Fungal pathogens may cause madarosis either by infecting the hair itself or the hair follicle. They will then produce an enzyme, which breaks down keratin, damaging the hair, or the hair follicle. This may also lead to inflammation of the follicle. All of these occurrences, alone or together, may then lead to hair loss of the eyelashes or eyebrows.³ 

Common fungal pathogens involved 

Trichophyton species

Trichophyton is a commonly encountered dermatophyte. It is the causative agent of multiple known fungal infections like ringworm or athlete’s food. Although anyone may contract it, certain groups are at a higher risk. These include those with immunodeficiencies, individuals who often use shared, public sports facilities (showers, lockers, equipment), those who partake in contact sports with a lot of skin-to-skin contact like wrestling, people who have increased contact with animals, or those who have hyperhidrosis (sweat excessively).⁴ 

Paracoccidioides species

Paracoccidioides is a fungus, which causes systemic infection (an infection which spreads throughout the body) and is endemic to areas of South and Central America. This infection more commonly affects those who undertake agricultural work as the infection is contaminated through breathing in Paracoccidioides from the environment, often from, for example, soil.⁵ 

Symptoms

The most obvious symptom of madarosis is loss of eyelashes or eyebrow hairs. Some further symptoms, which may help indicate fungal infection to be the cause include redness, dry patches, and swelling of the eyelids, or skin around the eyebrows, as well as itchiness for Trichophyton infection. For Paracoccidioides-related madarosis, there may be some systemic symptoms including fever, fatigue, cough, swelling of the lymph nodes, weight loss, or further lesions in the mouth, throat, or skin.^4,5

Diagnosis of fungal infections causing madarosis

Clinical examination 

When visiting the doctor, they should be able to determine madarosis by inspecting the eyelashes and eyebrows for the patterns of hair loss. They may also perform an eye exam to check the skin surrounding the eyes as well as the eyes themselves to make sure that the eye itself has not been compromised by checking for the presence of any vision changes. They may be able to determine the cause of the madarosis by listening to any additional symptoms or by observing the affected areas. 

Laboratory tests 

More often, if the madarosis is of an infectious cause, the doctor may take a sample of the hairs or take a biopsy of the surrounding skin if affected. These samples will then be sent to the laboratory to undergo microscopic examination to check the fungal morphology (structural features). Other diagnostic tests may also be run such as cultures, or a polymerase chain reaction to identify the causative fungus.^1,6 

Treatment 

Antifungal therapy 

The most common treatment for fungal-caused madarosis is the use of antifungal drugs. These may come in many forms, including creams, ointments, or oral tablets.

Madarosis management 

Although treatment of madarosis may allow regrowth of the hairs, for some people it may not be possible due to scarring occurring. The irreversible loss of someone’s eyelashes or eyebrows may cause feelings of embarrassment or low self-esteem, which could then develop into more serious mental health issues like depression or anxiety. Hence, some people may opt for cosmetic approaches to attempt to return to their previous appearance and manage the feelings associated with hair loss. These may include applying fake eyelashes or tattooing on eyebrows. Some may opt for surgical options including follicular unit transplantation of the eyebrows. For eyelashes, some people may decide to undergo an eyelash grafting procedure involving follicle insertion into the eyelids.² 

Prevention 

Personal hygiene 

The most effective way to prevent fungal-caused madarosis is to keep good personal hygiene. This would involve regularly cleaning the face and eyelids with an appropriate facial wash. It would also include avoidance of sharing personal items such as face towels or mascara to avoid potential fungal transmission from person-to-person. 

Environmental controls 

It is also key to keep living areas clean to reduce dampness and prevent mould growth to decrease the chance of any potential exposure to fungi. 

Early detection and treatment 

Seeking medical care as soon as possible would be beneficial as it would allow for sooner access to treatment. This will prevent the infection from progressing, stopping it from reaching a more extensive or serious state and leading to less severe disease consequences.⁴ 

FAQ’s

Is madarosis reversible?

Depending on the type of madarosis it may be reversible. If the madarosis was non-scarring and treatment for the underlying cause was administered, the eyelashes and eyebrows should grow back. 

What is madarosis caused by?

Madarosis may be caused by many different things. It could result from an autoimmune condition, nutritional deficiencies, certain dermatologic (skin) or ophthalmic (eye) conditions, or infections caused by parasites, viruses, bacteria, or fungi. 

Is madarosis permanent?

Depending on the type madarosis could be permanent if scarring has occurred. This type of permanent madarosis may then be tackled with cosmetic surgery involving eyelash or eyebrow grafts. 

How to cure madarosis?

Curing madarosis depends on what is causing it. For example, if the cause was bacterial, antibiotics would be used. If the cause was fungal, antifungals would be used, and if the cause was nutritional deficiencies then taking supplements to restore the optimal levels of the nutrient would be recommended.

What makes a person prone to fungal infections?

Many fungal pathogens tend to be opportunistic so immunodeficient people may be more likely to develop a fungal infection. Certain behaviours or environments may also put people at a higher risk of fungal infection contraction, for example, poor personal hygiene may put people at higher risk of superficial fungal infections like candidiasis. 

What kills fungus in the body?

Antifungal drugs are used to kill fungi in the body by targeting specific fungal processes or structures to cause cell death. 

Summary

Madarosis is a condition with multiple causes, which ultimately is defined by the loss of eyelashes or eyebrow hairs. One type of possible cause is fungal infection of the hair or hair follicles most commonly caused by dermatophytes. Due to fungal causes, it may present with additional symptoms like fever or dry patches. A doctor will often attempt to detect and treat the underlying cause of madarosis as well as check for any vision changes to rule out the eyes themselves being infected. For fungal-caused madarosis, a common treatment option would include antifungal drugs and some people may also opt for madarosis management options like fake eyelashes or cosmetic procedures. It is important to maintain proper hygiene as well as seek treatment early to prevent fungal madarosis itself or its development.