When Your Eyebrow Hair Loss Isn't A Result Of Over-Plucking

Scalp hair loss may be a common complaint among men and women, but in my practice, loss of eyebrow hair is a major concern among my female patients. Because eyebrows frame the face, hair loss in this area can dramatically change one's appearance, and since eyebrow hair loss is not easily concealed, it can be, for some women, an even more devastating loss than scalp hair loss.

I can't tell you how many women come into my office fretting about the fact that they've over-plucked. While this is certainly a possibility (plucking the eyebrows damages the hair follicle, and with repeated plucking, the follicle can get damaged to the point that it can no longer produce a hair), there are actually a number of both external and internal causes and conditions that can lead to temporary or permanent loss of eyebrows.

External
Several skin conditions, including psoriasis, eczema, and seborrheic dermatitis, don't directly lead to hair loss, but cause inflammation (a symptom of these conditions) near the brow that may be to blame. The urge to scratch and rub the inflamed area can indirectly cause eyebrow hairs to fall out. Loss that occurs in this manner is usually patchy, but as it is generally non-scarring (the hair follicle is intact), eyebrows can and often do grow back.
An infection that affects the hair follicle or the hair shaft can also lead to eyebrow hair loss. Like an inflammatory condition, an infection may have associated inflammation that can cause hair loss. A skin growth in the brow area, for example. whether it's benign (like a mole) or cancerous, may push the hair out, too.
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Internal
But, interestingly — and what most people don't initially realize — is that eyebrow hair loss is often a sign of an internal disease. The classic example of this is an under-active or over-active thyroid. Loss of the outer third of the eyebrow, in particular, is a characteristic sign of an under-active thyroid. Fortunately, thyroid conditions are easily treatable, usually with oral medications, but the medications generally have to be taken for life. The eyebrows should grow back, but there is always the possibility that they may not. The thyroid gland plays a huge role in our bodies, so it is important to have any thyroid issues treated.

Other hormonal disorders, autoimmune diseases, and nutritional deficiencies may also be associated with eyebrow loss. In some instances, eyebrow hair loss can be a reaction to a medication.
Hair Loss Conditions
Scalp hair loss may affect the eyebrows. Alopecia areata, an autoimmune condition in which the body's immune system mistakenly attacks the hair follicles, causes a non-scarring loss (so the hair follicles are still there), which may appear as bald spots or total brow loss. But, aside from the hair loss, the skin looks completely normal.
Lichen planopilaris and frontal fibrosing alopecia inflammatory conditions, in which the inflammation destroys the hair follicle, can cause a scar or permanent hair loss (usually present as red patches with redness and scale around each hair follicle). In the very advanced stages, they may appear as smooth, bald patches where the hair follicles have been destroyed. Androgenetic hair loss is another non-scarring type. The most common type of hair loss, it is due to the complex interplay of genes, hormones, and age.

Stress & Illness
Telogen effluvium, a type of scalp hair loss characterized by hair shedding, may affect the eyebrows as well. It can be caused by any emotional or physiological stress, for example acute or chronic illnesses, hormonal changes, nutritional deficiencies, and medications that alter the normal hair cycle and cause the hair the enter the telogen phase prematurely.

Another condition worth mentioning that can cause eyebrow loss is trichotillomania, which is a psychiatric disorder characterized by the urge to pull one's own hair out. Like over-plucking, it can lead to permanent hair loss after repeated pulling.

Treatments
The first step in treatment is to identify the cause of the hair loss. Then, treat it appropriately. If an internal cause is the culprit, it should be addressed — for example, thyroid medication for thyroid disease or supplements for a nutritional deficiency. External skin conditions are often treated with topical medications, and, once treated, the hair loss usually recovers. I often recommend Latisse as an adjunctive treatment. Though frequently associated with eyelash lengthening, it is a great option for thickening brows. In fact, people with brows that thin with aging (I typically don't see this in women under 50) may want to opt for Latisse.

And, of course, there is a whole world of cosmetics and great new brow treatments that can help.
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