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  • Madarosis is characterized by either complete or partial loss of eyebrow or eyelash hair.

  • Etiologies of eyebrow and eyelash alopecia include autoimmune, endocrinologic, genetic, infectious, neoplastic, nutritional, and traumatic conditions.

  • The purpose of this chapter is to provide an updated overview on the symptomatology, diagnosis, trichoscopy findings, and treatment of eyebrow and eyelash alopecia.


  • Trichoscopy is a useful tool to aid in diagnosis madarosis related to alopecia areata, frontal fibrosing alopecia, tinea infection, and trichotillomania.


  • Treatment of madarosis is centered on identifying and addressing the underlying disease.

  • Few standardized diagnostic pathways and treatment regimens exist in the management of eyebrow and eyelash alopecia.


  • Eyebrow and eyelash alopecia can occur in isolation or in conjunction with other symptomatology, necessitating a thorough history and physical exam.


  • Due to the varied functional and emotive purposes of eyebrows and eyelashes, as well as the visibility of the hairs, madarosis has been associated with significant emotional and psychological distress.

  • In contrast to scalp frontal fibrosing alopecia (FFA), eyebrows affected by FFA often demonstrate non-scarring features on trichoscopy and histology.


  • Etiologies for madarosis are varied, and accurate diagnosis is the first step in clinical management.


  • Due to the varied causes of eyebrow and eyelash loss, patients should be evaluated by a dermatologist for proper diagnosis and treatment.


Complete or partial eyebrow and eyelash loss can present as an isolated finding, or as the presenting manifestation of an underlying systemic pathology. Due to the many functional and cosmetic roles of eyebrows and eyelashes, madarosis can cause significant distress to patients, necessitating recognition of potential associated underlying diseases and treatments. Etiologies of madarosis are varied, and include autoimmune, endocrinologic, infectious, genetic, neoplastic, nutritional, and traumatic conditions. Madarosis can be classified as scarring or non-scarring, depending on the cause. Given the extensive breadth of etiology, prompt and accurate diagnosis is the first step in clinical management. Unfortunately, few standardized diagnostic pathways and treatment regimens exist in the management of eyebrow and eyelash alopecia, further underscoring the importance of early recognition and treatment. In this chapter, we comprehensively discuss the clinical features, diagnostic tips, and management of madarosis.



Alopecia areata (AA) involving the eyebrows presents as bilateral patchy eyebrow loss, whereas eyelash involvement, or milphosis, often presents as bilateral, patchy eyelash loss in the upper and lower eyelids (Figs. 45.1A and 45.2A). Although isolated eyelash involvement is rare, eyelash alopecia has been reported as the presenting sign of alopecia areata, particularly of severe alopecia areata.1–3

Figure 45.1

(A) Clinical image of alopecia areata of the eyebrows and eyelashes, demonstrating patchy, bilateral loss of eyebrow ...

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