What Is Madarosis

Overview

Have you ever heard of madarosis? This term refers to the complete or partial loss of eyelashes or eyebrows, which is different from mitosis, which is the term used to refer to just the loss of eyelashes.¹ Madarosis can be classified as ciliary and superciliary madarosis, which are characterised by eyelash loss and eyebrow hair loss, respectively. Moreover, it can also be classified as scarring or non-scarring, with scarring madarosis being characterised by an irreversible loss of hair in the affected area. Although this clinical sign can be present as an isolated finding, it is usually linked to an underlying systemic pathology. In this way, although madarosis might seem an innocuous sign, it can be a manifestation of a serious disorder.² Throughout this article, you will be able to learn more about this clinical sign, which might be the nightmare of many, by reading about its causes, symptoms, and treatments.

Causes of madarosis

As stated above, madarosis is often triggered by an underlying pathology. In this way, madarosis can be classified according to its causes, with the main ones being:²

• Ophthalmological conditions: madarosis can be a feature of different vision conditions. As an example, it can be triggered by posterior blepharitis, which refers to any variety of dysfunction of the meibomian glands, which are located along the eyelid margins
• Dermatologic conditions: this includes eczemas (e.g. atopic dermatitis), keratinising disorders, bullous disorders, hair shaft disorders, inflammatory disorders of hair and appendages, papulosquamous disorders (e.g. psoriasis), and non-inflammatory disorders of hair
• Miscellaneous: the causes of what is referred to as miscellaneous madarosis usually involve follicular mucinosis, and cutaneous sarcoidosis
• Systemic diseases such as hypothyroidism, hyperthyroidism, hypopituitarism, amyloidosis, hyperparathyroidism, hypoparathyroidism, and pituitary necrosis syndrome
• Autoimmune disorders: such as localised scleroderma, which is a chronic connective tissue disease with a considerably low incidence,³ and alopecia areata, in which the immune system attacks hair follicles
• Nutrition: madarosis can also be triggered by nutritional deficiencies. For example, it can be caused by marasmus, which is a severe manifestation of malnutrition,⁴ and by zinc, biotin, and iron deficiencies
• Infections: infections such as leprosy, folliculitis, HIV infection, herpes simplex and zoster, and syphilis can lead to developing madarosis
• Mental health disorders: such as trichotillomania, which is characterised by a recurrent and irresistible urge to pull out hair from your scalp or eyebrows. The development of this disorder is usually linked to either genetics or stress
• Chemical and thermal injuries
• Use of drugs: such as chemotherapy drugs and botulinum A toxin (which is a neurotoxin used in botox)
• Exposure to toxic substances such as mercury, arsenic or gold
• Neoplasms such as leukaemia and sebaceous gland carcinoma
• Inherited disorders such as Hallermann-Streiff syndrome, and Marie-Unna hypotrichosis, which is an autosomal dominant non-scarring alopecia characterised by its pattern of hair loss⁵

Signs and symptoms of madarosis

The main sign of madarosis is the partial or total loss of eyebrows or eyelashes. The other symptoms linked to madarosis depend on the underlying pathology of this sign. In this way, if madarosis is caused by a dermatological condition such as atopic dermatitis, it will probably display with redness or itching. However, this would not be a sign of madarosis but of the underlying pathology (dermatitis) itself. Nevertheless, madarosis can cause significant emotional and psychological distress to patients due to the functional and emotive purposes of eyebrows and eyelashes. In fact, it has been demonstrated that 25% of women suffering from madarosis have reported to have developed anxiety due to the loss of their eyebrows or eyelashes. Furthermore, 52% of them reported being afraid of what people could think about them for having lost their eyebrows or eyelashes either completely or partially.¹

Management and treatment for madarosis

The main strategy for managing and treating madarosis is to treat the pathology underlying this clinical sign, which may include:

• Treating alopecia areata: treatment of this condition includes steroids, topical immunotherapy, and immunosuppressants to prevent the immune system from attacking the hair follicles.⁶ In those cases where madarosis is caused by alopecia areata, treating this condition will help manage and treat madarosis
• Treatment of infectious diseases that result in madarosis: treating diseases such as syphilis, which can be managed with benzathine penicillin G, can help prevent the loss of the eyebrows or eyelashes¹
• Treating trichotillomania: the first-line treatment for trichotillomania is psychotherapy. In this way, by undergoing psychological treatment, patients suffering from this hair-pulling disorder might be able to treat their madarosis
• Treating zinc deficiency: nutritional problems such as zinc deficiency can be treated by the administration of oral zinc supplements¹

In reference to cases where madarosis is a consequence of the administration of a drug, either by substituting the actual medication with another drug or by stopping it, madarosis can be treated. However, stopping the medication might have more serious consequences than the madarosis itself has (e.g. stopping chemotherapy in a patient with cancer) and is thus not an option for most patients. Furthermore, although in some cases, it might be possible to find a substitute drug, in some, it might not. Therefore, it is sometimes complex to treat madarosis if it is a consequence of a medication.

In contrast with the previous examples, follicular unit transplantations are a useful method for treating scarring madarosis, which, instead of being based on treating the underlying pathology, only treats the hair loss. This method is usually used in cases where madarosis is irreversible (scarring madarosis).² Although, as mentioned, hair transplantations do not treat the underlying condition or disorder that led to madarosis, they do reduce the distress that hair loss causes to patients. In this way, if a patient has lost the eyebrows (superciliary madarosis), it is possible to get an eyebrow transplantation. In fact, as eyebrows are considered to be an expressive feature and are considered to be very important, eyebrow transplantations have become a popular procedure.⁷

Prevention

It can be difficult to prevent madarosis as, as shown, it can be caused by many different disorders (e.g. cancer, autoimmune disorders, ophthalmological conditions). By maintaining a balanced diet (which can prevent the development of madarosis due to nutritional deficiencies) and reducing stress (which is a risk factor for trichotillomania and is associated with hair loss as it pushes hair follicles into a resting phase), people can make changes to their lifestyle that will benefit their health and might help to decrease the risk of developing madarosis.

When should I see a doctor?

The main risk linked to madarosis is that it can be a sign of a serious condition or disorder. This means that it is important to see a doctor as soon as possible as this can allow treatment of the underlying pathology to happen more effectively and faster. As soon as you experience a considerable loss of eyelashes or eyebrows, seeing a doctor would be recommended so that the cause of this loss can be determined.

Summary

Madarosis refers to the partial or complete loss of eyebrows (superciliary madarosis) or eyelashes (ciliary madarosis). This clinical sign has many causes as it is usually present as a consequence of an underlying condition or disorder (e.g. an autoimmune disorder such as alopecia areata, a skin disorder, or leukaemia). Due to this, the main strategy for managing and treating madarosis is based on treating the underlying pathology, which is, in most cases, more worrying than the madarosis itself.