Hair and eyebrow loss affects many people and can arise from a wide range of causes, from autoimmune conditions and thyroid disorders to nutritional deficiencies and certain medications. Understanding why hair loss is occurring is the essential first step towards effective management. This article covers the most common causes of combined or isolated hair and eyebrow loss, when to seek medical advice, what tests are available on the NHS, and the treatment options currently licensed in the UK — alongside practical guidance on living well and finding support.
Summary: Hair and eyebrow loss can result from autoimmune conditions such as alopecia areata, thyroid disorders, nutritional deficiencies, medications, or scarring conditions, each requiring a different treatment approach.
- Alopecia areata is a common autoimmune cause of simultaneous scalp and eyebrow loss, ranging from patchy loss to total body hair loss (alopecia universalis).
- Thyroid dysfunction — particularly hypothyroidism — is a recognised cause; thinning of the outer third of the eyebrow ('Queen Anne's sign') is a classic but non-specific feature.
- JAK inhibitors baricitinib and ritlecitinib are MHRA-licensed in the UK for severe alopecia areata and require specialist initiation, baseline screening, and ongoing safety monitoring.
- Scarring alopecias such as frontal fibrosing alopecia cause permanent follicle destruction if untreated, making early dermatology referral essential.
- High-dose biotin supplements can interfere with thyroid function tests and troponin assays; patients should inform their clinician before blood tests are taken.
- NHS psychological support, including NHS Talking Therapies, and charities such as Alopecia UK are available for those experiencing distress related to hair loss.
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Common Causes of Hair and Eyebrow Loss
Alopecia areata, thyroid disorders, androgenetic alopecia, fungal infections, and nutritional deficiencies are among the most common causes of hair and eyebrow loss, each with distinct clinical features.
Hair and eyebrow loss can occur together or independently, and understanding the underlying cause is essential for appropriate management. One of the most common causes affecting both areas simultaneously is alopecia areata, an autoimmune condition in which the immune system mistakenly attacks hair follicles. It can affect any hair-bearing area of the body and may present as patchy loss, complete scalp hair loss (alopecia totalis), or total body hair loss (alopecia universalis).
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Thyroid disorders — both hypothyroidism and hyperthyroidism — are another frequent cause. The thyroid gland regulates metabolism and plays a key role in hair follicle cycling. Thinning of the outer third of the eyebrows, known as the 'Queen Anne's sign', is a classic feature of hypothyroidism, though it is not exclusive to this condition. Other hormonal imbalances, including those associated with polycystic ovary syndrome (PCOS) or the menopause, can also contribute to diffuse hair thinning. Androgenetic alopecia (pattern hair loss) is one of the most common causes of scalp hair loss in both men and women and should be considered as part of the differential diagnosis.
Several other conditions can affect the scalp, eyebrows, or both:
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Tinea capitis or tinea faciei — fungal infections that can cause patchy hair loss with scaling; in children, a tender, boggy, inflamed plaque with broken hairs (a kerion) requires urgent assessment to prevent permanent scarring
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Seborrhoeic dermatitis, atopic dermatitis, and psoriasis — inflammatory skin conditions that can affect the scalp and eyebrow area; blepharitis (inflammation of the eyelid margins) may accompany eyebrow involvement
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Traction alopecia — caused by prolonged tension on hair from tight hairstyles
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Trichotillomania — a hair-pulling disorder that can affect the scalp, eyebrows, and eyelashes
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Telogen effluvium — a temporary shedding triggered by physical or emotional stress, illness, surgery, or childbirth; this primarily affects the scalp, and eyebrow involvement is less typical
Nutritional deficiencies are a recognised but sometimes overstated cause. Low iron stores (ferritin) have the strongest evidence for contributing to hair loss and should be assessed in appropriate clinical contexts. Vitamin D and zinc deficiencies may be relevant in selected cases, but routine testing and supplementation are not generally recommended without clinical indication. Biotin deficiency is rare in people eating a varied diet, and routine biotin supplementation is not advised; importantly, high-dose biotin supplements can interfere with certain laboratory assays — including thyroid function tests and troponin — potentially producing misleading results (MHRA Drug Safety Update). Patients taking biotin supplements should inform their healthcare professional before blood tests are taken.
Certain medications — including retinoids, anticoagulants, and chemotherapy agents — are also well-recognised causes. Patients should review their medicines with a healthcare professional if hair loss coincides with starting a new treatment.
| Cause | Areas Affected | Key Features | Initial Investigation | Treatment Approach |
|---|---|---|---|---|
| Alopecia areata | Scalp, eyebrows, eyelashes, any hair-bearing area | Autoimmune; patchy loss; may progress to totalis or universalis | Clinical diagnosis; scalp biopsy if uncertain; FBC, TFTs | Topical/intralesional corticosteroids; JAK inhibitors (baricitinib, ritlecitinib) for severe disease |
| Thyroid disorder | Scalp, outer third of eyebrows | Hypothyroidism: 'Queen Anne's sign'; diffuse thinning; fatigue, weight change | TSH (primary screen); TFTs | Treat underlying thyroid condition; regrowth expected once euthyroid |
| Androgenetic alopecia | Scalp (patterned) | Commonest cause of scalp loss in men and women; gradual onset | Clinical diagnosis; testosterone/SHBG if hyperandrogenism suspected | Topical minoxidil; oral finasteride (men only, UK licence); anti-androgens for women under specialist care |
| Telogen effluvium | Scalp primarily | Diffuse shedding 2–3 months after stress, illness, surgery, or childbirth; usually temporary | FBC, serum ferritin, TFTs, B12/folate | Address trigger; correct nutritional deficiencies; reassurance; spontaneous recovery typical |
| Tinea capitis / tinea faciei | Scalp, eyebrow area | Patchy loss with scaling; kerion (boggy, inflamed plaque) requires urgent treatment | Fungal microscopy and culture from scalp scrapings | Systemic antifungals (oral terbinafine or griseofulvin); topical antifungals alone insufficient |
| Nutritional deficiency | Scalp; eyebrows less typical | Low ferritin has strongest evidence; biotin deficiency rare on varied diet | Serum ferritin; B12/folate; vitamin D/zinc if clinically indicated | Correct identified deficiency; routine supplementation not advised without indication |
| Scarring alopecia (e.g., frontal fibrosing alopecia, lichen planopilaris) | Frontal hairline, eyebrows, eyelashes | Permanent follicle destruction if untreated; frontal fibrosing alopecia affects post-menopausal women disproportionately | Scalp biopsy; dermoscopy; urgent dermatology referral | Early specialist referral essential; treatment aims to halt progression |
When to See a GP or Dermatologist
See your GP promptly if hair or eyebrow loss is sudden, patchy, or accompanied by scalp inflammation, systemic symptoms, or a new medication, as early assessment can prevent permanent scarring.
Whilst some degree of hair shedding is entirely normal — losing up to 100 scalp hairs per day is considered within the typical range — certain patterns and associated symptoms warrant prompt medical attention. You should contact your GP if you notice:
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Sudden or rapidly progressive hair or eyebrow loss
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Loss occurring in distinct patches
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Associated scalp symptoms such as redness, scaling, itching, or pain
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Hair loss accompanied by fatigue, weight changes, or feeling unusually cold or warm (which may suggest a thyroid problem)
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Loss following a new medication or significant illness
Seek prompt GP assessment if you or your child develops a tender, boggy, or inflamed area of the scalp with broken hairs, scaling, or pustules. This may indicate a kerion (a severe inflammatory reaction to tinea capitis), which requires urgent treatment — usually with systemic antifungals — to prevent permanent scarring. Marked inflammation or crusting along the eyelid margins (blepharitis) alongside eyebrow loss should also be assessed promptly.
Early assessment is particularly important when scarring alopecia is suspected. Conditions such as lichen planopilaris or frontal fibrosing alopecia cause permanent destruction of hair follicles if left untreated, making timely referral to a dermatologist essential. Frontal fibrosing alopecia, which disproportionately affects post-menopausal women, characteristically causes recession of the frontal hairline alongside eyebrow and eyelash loss.
Your GP will typically take a thorough history and may arrange initial blood tests before referring to a dermatologist if the diagnosis remains unclear or if specialist treatment is required. NHS dermatology referrals are made via the standard referral pathway, and waiting times vary by region. Some people choose to consult a trichologist privately; trichologists are not medically qualified and are not part of standard NHS referral pathways, so it is advisable to check a practitioner's credentials and to keep your GP informed of any advice received.
In cases where hair loss is causing significant psychological distress — which is entirely valid and common — it is equally appropriate to raise this with your GP, as mental health support may be beneficial alongside physical treatment. Do not feel that cosmetic concerns are insufficient reason to seek help; hair loss can profoundly affect self-esteem and quality of life.
Diagnosis and Tests Available on the NHS
First-line NHS investigations include full blood count, thyroid function tests, and serum ferritin; scalp biopsy and dermoscopy may be arranged by a dermatologist if a scarring or autoimmune cause is suspected.
Diagnosing the cause of hair and eyebrow loss typically begins with a detailed clinical history and physical examination. Your GP will ask about the pattern and duration of loss, family history, recent illnesses or stressors, dietary habits, and current medications. This information helps to narrow the differential diagnosis considerably before any tests are ordered.
Blood tests are usually the first-line investigation. In line with NICE CKS and PCDS guidance, these typically include:
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Full blood count (FBC) — to check for anaemia
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Thyroid function tests (TFTs) — to assess for hypothyroidism or hyperthyroidism (TSH is the primary screening test)
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Serum ferritin — a sensitive marker of iron stores
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Vitamin B12 and folate — where dietary risk factors or malabsorption is suspected
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Coeliac serology — if coeliac disease is a possibility based on history or symptoms
Vitamin D and zinc levels may be checked in selected cases where there is a clinical reason to suspect deficiency, but are not recommended as routine first-line tests for hair loss. If features of hyperandrogenism or PCOS are present, your GP may request total testosterone and sex hormone-binding globulin (SHBG); the LH/FSH ratio is not recommended for diagnosing PCOS under current NICE guidance (NICE NG23). Inflammatory markers (ESR, CRP) may be added if an autoimmune or inflammatory cause is suspected.
If a fungal infection (tinea capitis or tinea faciei) is suspected — particularly in children or those with scalp scaling and broken hairs — your GP may arrange fungal microscopy and culture from scalp scrapings or hair samples. This is important to confirm the diagnosis and guide antifungal treatment.
If alopecia areata or a scarring condition is suspected, a scalp biopsy may be performed by a dermatologist. This involves taking a small skin sample under local anaesthetic for histological analysis, which can confirm the diagnosis and guide treatment. Dermoscopy — a non-invasive technique using a handheld magnifying device — is increasingly used in dermatology clinics to examine the scalp and follicular patterns in detail. In some instances, a hair pull test may be performed in clinic to assess the proportion of hairs in the shedding phase.
Patients should be reassured that many causes of hair and eyebrow loss are identifiable and manageable once the correct diagnosis is established.
Treatment Options for Hair and Eyebrow Loss
Treatment depends on the underlying cause; options range from topical corticosteroids and minoxidil for alopecia areata to MHRA-licensed JAK inhibitors for severe disease, all requiring clinician supervision.
Treatment for hair and eyebrow loss depends entirely on the underlying cause, and there is no universal solution. Where a specific trigger is identified — such as a thyroid disorder, nutritional deficiency, or medication — addressing that root cause often leads to natural regrowth over several months. Patients should be counselled that hair regrowth is typically slow, and realistic expectations are important.
For alopecia areata, several treatment options are available depending on the extent of involvement:
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Potent topical corticosteroids are commonly used as first-line treatment for patchy alopecia, including eyebrow loss
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Intralesional corticosteroid injections (e.g., triamcinolone acetonide) can be effective for localised patches and are administered by a dermatologist
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Topical minoxidil may support regrowth in some cases. It is licensed in the UK for androgenetic alopecia of the scalp only; its use for alopecia areata or eyebrow loss is off-label and should be under clinician supervision. Potential side effects include scalp or skin irritation, contact dermatitis, and unwanted hair growth (hypertrichosis) in adjacent areas. Minoxidil should be avoided during pregnancy and breastfeeding
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JAK inhibitors represent a newer class of treatment for severe alopecia areata. Both baricitinib (Olumiant®) and ritlecitinib (Litfulo®) are MHRA-licensed in the UK: baricitinib is approved for severe alopecia areata in adults, and ritlecitinib for severe alopecia areata in adults and adolescents aged 12 years and over. These medicines must be initiated and supervised by a specialist. Important safety considerations include an increased risk of serious infections (including reactivation of tuberculosis and herpes zoster), venous thromboembolism, and other class-related risks outlined in the MHRA Drug Safety Update on JAK inhibitors. Baseline screening (including TB and hepatitis status), ongoing monitoring, and appropriate contraception advice are required. Patients should discuss the full benefit–risk profile with their specialist
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Contact immunotherapy (e.g., with diphencyprone, DPCP) is a specialist option for extensive or treatment-resistant alopecia areata, available in some NHS dermatology centres
For androgenetic alopecia (pattern hair loss), topical minoxidil is the most widely used treatment. Oral finasteride 1 mg is licensed in the UK for men only. Important risks include sexual dysfunction (including reduced libido, erectile dysfunction, and ejaculatory disorders) and an association with depression and suicidal ideation (MHRA Drug Safety Update); patients should be counselled about these risks before starting treatment. Finasteride must not be handled by women who are pregnant or may become pregnant, due to the risk of harm to a male foetus. In the UK, finasteride 1 mg for hair loss is often prescribed privately. Women with hormonally driven hair loss may benefit from anti-androgen therapies under specialist supervision.
For eyebrow-specific loss, bimatoprost — a prostaglandin analogue originally used in glaucoma — has shown some evidence of promoting eyebrow regrowth, but it is not licensed for this indication in the UK. Its use for eyebrows is off-label and should only be considered under specialist supervision. Potential adverse effects include periorbital skin pigmentation, periorbital fat atrophy, and — if it contacts the eye — potential changes in iris colour. Patients should be made aware of these risks.
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For tinea capitis, systemic antifungal treatment (typically oral terbinafine or griseofulvin, depending on the causative organism and patient age) is required; topical antifungals alone are insufficient.
Cosmetic options such as microblading or semi-permanent make-up can provide an effective interim solution whilst awaiting regrowth. These procedures carry a risk of infection and should be deferred if the skin is actively inflamed; always choose a reputable, appropriately trained practitioner who follows UK hygiene and safety standards.
NHS provision of wigs and hairpieces is available for patients with certain conditions, including alopecia areata and those undergoing chemotherapy. Eligibility criteria, charges, and exemptions vary across England, Scotland, Wales, and Northern Ireland; your GP or dermatologist can advise on local arrangements.
If you suspect that a medicine is causing hair loss or another side effect, you can report this to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.
Living With Hair Loss: Support and Practical Advice
Alopecia UK and NHS Talking Therapies offer peer support and psychological help; NHS wig provision is available for eligible patients, with eligibility varying across UK nations.
Living with hair and eyebrow loss can have a significant emotional and psychological impact, affecting confidence, body image, and social wellbeing. It is important to acknowledge that these feelings are entirely valid, regardless of whether the hair loss is considered 'medically significant'. Many people find that the visible nature of hair loss makes it particularly difficult to manage in daily life, and seeking support is a positive and proactive step.
Practical tips for day-to-day management include:
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Using gentle, sulphate-free shampoos and avoiding excessive heat styling
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Considering lightweight wigs, hairpieces, or hair fibres — NHS wig provision is available for eligible patients with certain conditions, including alopecia areata and those undergoing chemotherapy; charges and exemptions vary by UK nation, so ask your GP or care team about local arrangements
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Exploring semi-permanent eyebrow solutions such as tinting, microblading, or brow pencils to restore appearance whilst treatment takes effect; ensure any cosmetic procedure is carried out by a reputable, appropriately trained practitioner, and avoid these treatments if the skin is actively inflamed or infected
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Protecting the scalp and brow area from sun exposure, as hair-bearing skin provides UV protection
From a psychological perspective, Alopecia UK is a leading charity offering peer support, information resources, and community events for people affected by all forms of alopecia. The British Association of Dermatologists (BAD) also provides patient information leaflets on alopecia areata and scarring alopecias, which are available on their website.
The NHS provides access to psychological therapies through NHS Talking Therapies (formerly known as IAPT), which offers support for anxiety and low mood and is available via self-referral in many areas of England; equivalent services exist in Scotland, Wales, and Northern Ireland. This can be particularly helpful for those experiencing psychological distress related to hair loss.
Healthcare professionals should approach conversations about hair loss with sensitivity, recognising the condition's impact on quality of life. NICE guidance on long-term conditions emphasises the importance of shared decision-making and holistic support. Patients are encouraged to maintain open communication with their GP or dermatologist, report any changes in their condition, and not hesitate to ask for a referral to psychological support services if needed. Recovery — whether through regrowth or adaptation — is a journey, and no one should feel they need to manage it alone.
Frequently Asked Questions
Can hair and eyebrow loss be a sign of a serious medical condition?
Yes, combined hair and eyebrow loss can indicate underlying conditions such as thyroid disorders, alopecia areata, or scarring alopecias like frontal fibrosing alopecia. It is important to see your GP for assessment, particularly if loss is rapid, patchy, or accompanied by other symptoms such as fatigue or scalp inflammation.
What treatments are available on the NHS for alopecia areata affecting the eyebrows?
NHS treatments for alopecia areata include potent topical corticosteroids and intralesional corticosteroid injections for localised patches, including eyebrow loss. For severe disease, the MHRA-licensed JAK inhibitors baricitinib and ritlecitinib may be prescribed by a specialist, subject to eligibility and safety screening.
Should I take biotin supplements if I am experiencing hair and eyebrow loss?
Routine biotin supplementation is not recommended for hair loss, as true biotin deficiency is rare in people eating a varied diet. High-dose biotin supplements can interfere with laboratory tests including thyroid function tests and troponin assays, so always inform your healthcare professional if you are taking them before any blood tests.
The health-related content published on this site is based on credible scientific sources and is periodically reviewed to ensure accuracy and relevance. Although we aim to reflect the most current medical knowledge, the material is meant for general education and awareness only.
The information on this site is not a substitute for professional medical advice. For any health concerns, please speak with a qualified medical professional. By using this information, you acknowledge responsibility for any decisions made and understand we are not liable for any consequences that may result.
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