Introduction

Did you know that 1 in 500 people suffer from something called Madarosis?¹

Madarosis is a term used to describe the loss of eyelashes and eyebrows, which can be complete or incomplete. It is often a sign of an underlying disorder, which can be confined to a small area or impact a large proportion of the body. As a sign of an underlying condition, madarosis is often accompanied by other symptoms. What other symptoms are experienced depends on the disorder causing them. 

Madarosis is derived from Greek and refers to hair loss or baldness.² The underlying causes of Madarosis must be understood due to the huge impact that some disorders can have on an individual's quality of life.

Overview of nutritional deficiencies

Nutritional deficiencies occur when the body lacks substances called nutrients that are essential for maintaining life. Without nutrients, the human body cannot grow and develop as it should, it will be more susceptible to diseases, and many of the processes essential to human life will be impacted. The body cannot naturally produce many nutrients that are essential for survival. Consequently, they must be obtained through eating a well-balanced, nutrient-rich diet.

Nutritional deficiencies can occur for various reasons, the two most common being a poor diet and issues with absorbing nutrients from foods.³ 

Although we may give hair little thought, many nutrients are specifically for hair health. Essential vitamins for hair health include vitamins A, B complex, C, D, and E. Minerals such as zinc, iron, and selenium are also essential. 

Nutritional Deficiencies Linked to Madarosis

Vitamin deficiencies

• Vitamin A helps to regulate and maintain hair follicles; a deficiency can lead to dry and brittle hair at risk of falling out⁴ 
• Vitamin B7, or biotin, is believed to promote hair health when in the right amount. This was concluded after case studies were carried out. However, too few studies have been conducted to confidently explain why biotin is effective in promoting hair health
  • Biotin-deficient individuals will experience symptoms such as a red rash around areas of the face, including the eyes, mouth, and nose; brittle nails; skin infection; and thinning or loss of hair⁵
• Niacin can be obtained through meat, including beef, pork, and fish; nuts and legumes; or avocados.⁶ Niacin deficiency may also be known as pellagra, causing symptoms such as dermatitis, diarrhoea, and even dementia
  • Dermatitis is the key symptom that may be linked to both niacin deficiency and madarosis. Severe malnutrition caused by niacin deficiency can cause hair loss in the eyes and eyelashes⁶ 

• Vitamin B12 is primarily involved in the development and functioning of the central nervous system (the brain and spinal cord) and the formation of healthy red blood cells, which carry oxygen to all areas of the body⁷
  • Like biotin, vitamin B12 supplements are often recommended to promote hair growth. This has been based on a few studies that have found that in cases of some patients shedding their hair, they also are vitamin B12 deficient⁸
  • Symptoms of vitamin B12 deficiency include extreme weakness, fatigue, breathlessness, dizziness, yellowing of the skin, sensations of pins and needles, mood changes, and some loss of the sense of touch.⁸ Hair loss and thinning may also be signs of madarosis

• Vitamin C is typically found in citrus fruits and vegetables. It plays an important role in collagen production, a protein that keeps hair strong and healthy.⁸ Without sufficient vitamin C, hair will become brittle, may be exposed to damage, or may be lost
• Vitamin D plays a crucial role in maintaining the hair growth cycle. A deficiency in vitamin D can disrupt this cycle, leading to excessive hair shedding. Specifically, the telogen phase, the third phase of the cycle, is characterised by a period when hair growth stops. When there is a lack of vitamin D, hair follicles are prematurely pushed into the telogen phase simultaneously, resulting in the shedding of many hairs simultaneously²

Mineral deficiencies

• Iron transports oxygen to hair follicles, thus encouraging hair growth. When iron levels are low, less oxygen reaches the hair follicles, causing hair growth to slow down and eventually leading to hair shedding
• Zinc is essential to life because it creates DNA and proteins and divides cells. Madarosis can be a sign of zinc deficiency, as can other symptoms such as skin conditions and unexplained weight loss² 

Other nutritional deficiencies

Protein deficiency

Proteins are the essential components of hair. They comprise amino acids necessary for keratin production, the key structural component of hair. Other functions of proteins in hair include promoting hair growth, strengthening strands, and maintaining moisture.⁹ Protein malnutrition may lead to a reduction in hair quality, thinning, or loss.¹⁰

Essential fatty acids

Essential fatty acids cannot be made naturally by the body; they must be obtained from external sources such as diet. Fatty acids play an important role in scalp health. 

Essential fatty acid deficiency may be seen in a loss of scalp hair and eyebrows, a sign of madarosis.¹¹

Diagnosis and assessment

Diagnosing nutritional deficiencies is crucial due to their impact on health. A range of tests may be performed to make a diagnosis.¹² Reviewing an individual's medical history is important as it helps doctors determine whether the deficiency is caused by an underlying condition or a poor or unbaled diet. 

A physical examination may also be carried out. This can help doctors identify madarosis and any other symptoms that may be indicators of malnutrition. Blood tests are frequently carried out to test nutrient levels in the blood. Low levels of a nutrient signify deficiency.

Hair analysis may be used to diagnose malnutrition. However, it works better alongside other diagnostic tools. Doctors look for any signs that the hair is in ill health. Indicators may include dryness, brittleness, discolouration, or hair that is easily plucked. The most evident sign of hair damage will be hair loss.  

Treatment and management

Modifying an individual’s diet is the main focus for treating and managing madarosis. A balanced diet of fruit, vegetables, nuts, seeds, fish, and meat provides the proper nutrients for healthy hair. 

Supplements may be given to bridge the gap if a balanced diet alone is unsuccessful. It is important to follow the guidelines when taking supplements, as too much can have adverse effects. 

When diagnosed with malnutrition, regular check-ups are important to monitor the effectiveness of treatment. This ensures that the symptoms do not worsen, improvements are being made, and that any treatment does not have adverse effects. Check-ups will allow adjustments to be made based on the response to treatment.

Prevention strategies

Education is of the utmost importance when it comes to health. Learning to look after our bodies prevents unnecessary illnesses while teaching the public signs of nutrition deficiency. Nutritional education can be carried out by providing resources and guidance on healthy, balanced diets. 

Individual counselling can help prevent malnutrition. This can include customised nutrition plans, changing diets, and goal setting, which encourage healthy eating.¹³

Importance of early detection

Early detection of nutrient deficiency is greatly important. It allows for quick intervention, effective management, and a better prognosis. The public already possessing knowledge of the symptoms can achieve this, thus enabling them to seek treatment immediately. In addition, routine health screenings enable early intervention. 

Summary

To summarise, recognising nutrients' role in madarosis is crucial for its prevention and treatment. Taking a holistic approach to treatment offers the best opportunity to treat madarosis and the underlying condition, thus restoring hair health and growth. Further research is required to understand how madarosis occurs due to nutrient deficiency.