As a trichologist, I’m seeing more and more menopausal and post-menopausal women who are complaining that they’re losing their eyebrows and have thinning hair around the front and side hairlines.

This problem is known as frontal fibrosing alopecia (FFA) and was first recognized in Australia in the 1990s. It is an autoimmune condition in which a group of white blood cells attacks and destroys the hair follicles in the affected areas. FFA has become the main scarring alopecia seen by trichologists.

The Role of Vitamin D in FFA

Vitamin D is commonly deficient in sufferers of hair loss, including FFA. It’s thought that FFA may be related to the application of sunscreen creams and lotions to the face, as these reduce the production of vitamin D in the skin and can lead to vitamin D deficiency.

The vitamin D connection was made when it was observed that some patients who started taking vitamin D3 (about 2000 IU daily) noticed improvement in their FFA. It has also been established that with scarring alopecias, the production of 7-dehydrocholesterol is disturbed, causing a reduction in vitamin D levels.

So how does vitamin D protect the hair? It is thought to help hair follicles retain their ‘immune privilege’, reducing their susceptibility to autoimmune attack; and as an antioxidant, it protects hair follicles from free radicals and oxidative damage that can lead to hair loss.

Why Women?

FFA is an autoimmune condition and autoimmune problems occur more in women than men, possibly related to higher estrogen levels (which seem to contribute to autoimmune problems). Paradoxically, however, FFA tends to occur when estrogen levels are reduced, such as after menopause. I have also seen female patients in their 70s who initially suffered from FFA after they stopped taking hormone replacement therapy (HRT).

Interestingly, there is a relationship between estrogen and vitamin D: as estrogen levels drop, so do vitamin D levels. This is why many women take vitamin D and calcium supplements at the time of menopause, to reduce the risk of osteoporosis. Vitamin D is needed for calcium absorption, and calcium is crucial for strong healthy bones.

Why FFA is on The Rise

Why has FFA only occurred in the past 30 years? One theory is that it is a delayed reaction in women who started taking oral contraceptives in the 1960s-70s. I personally feel that our reduced exposure to sunlight and the subsequent reduction of vitamin D3 production in the skin is also playing a part. Normally 90% of our vitamin D is produced by the action of sunlight on the skin (with the liver and kidneys converting it into an active form), but most of our lives are now spent working indoors and avoiding sunlight because of the risk of skin cancer. Our modern indoor lifestyles may therefore be contributing to FFA’s recent rise.

How to Treat Thinning Eyebrows

One possible therapy for loss of eyebrows is the topical application of Bimatoprost, an ophthalmic solution, twice daily. It was accidentally discovered that Bimatoprost and similar agents, used primarily to treat glaucoma, increased the growth of eyelashes. Studies with eyebrows have been positive, as long as the hair follicles are intact.

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