THE CLINICAL PICTURE Hiroki Matsuura, MD Yu Suganami, MD, PhD Department of General Internal Department of General Internal Medicine, Okayama City Hospital, Medicine, Okayama City Hospital, Okayama, Japan Okayama, Japan

Hypothyroidism, eyelash loss

77-year-old woman presented to our A outpatient department with chronic gen- eral fatigue and peripheral edema. She had mild hypertension and diabetes but no signifi cant cardiovascular or gastrointestinal problems. Physical examination revealed nonpitting edema in the legs and loss of eyelashes (Fig- ure 1) from all four . Her were also thin, but she said she usually trims them for makeup. She denied rubbing the , pulling the eyelashes, or having experienced previous eyelid injuries. Laboratory testing showed a high thyroid- Figure 1. stimulating hormone level of 33.7 μU/mL (ref- erence range 0.35–4.94), a low serum thyroxine Milphosis is also associated with a range of level, and the presence of antithyroid antibodies. diseases from localized dermatologic disease to Based on the presentation and fi ndings, the systemic disorders such as hypoparathyroidism, diagnosis was hypothyroidism with milphosis. infection (herpes zoster, tuberculosis, syphilis, Testing showed , Hansen disease), radiation, drug ef- a high thyroid- ■ CAUSES OF MILPHOSIS fects (heparin, androgens, retinoids, and angio- tensin-converting enzyme inhibitors), injury, stimulating Terms used for loss include milphosis, toxins (cocaine and thallium), zinc defi ciency, hormone level, , and alopecia. Milphosis is loss of biotin defi ciency, psoriasis, systemic lupus ery- eyelashes, madarosis is loss of eyelashes and thematosus, discoid lupus, and neoplasm (basal low serum , and alopecia is general loss of cell carcinoma and squamous-cell carcinoma).1 thyroxine, hair, but especially from the head. Milphosis can sometimes be useful as a Eyelashes and eyebrows have many roles physical symptom when it helps detect under- and presence such as protecting the eye (by preventing lying systemic disorders. However, clinicians of antithyroid sweat and water from entering), cosmetic ap- should also consider in the antibodies pearance, and social communication. differential diagnosis of patients with mil- Typically, milphosis is caused by thyroid phosis whose clinical history and laboratory disorders, as in this case. Both insuffi cient and fi ndings are unclear. In nonscarring milphosis, excessive levels of thyroid hormones are as- hair can regrow after the primary disease is ap- sociated with hair growth and cy- propriately treated. cling. In particular, hypothyroidism can cause Our patient received supplemental thyrox- telogen effl uvium (thinning or shedding of ine, but her eyelashes did not grow back. ■ hair resulting from the early entry of the hair ■ REFERENCES follicle into the resting phase), early graying, 1. Jordan DR. Eyelash loss. Semin Plast Surg 2007; 21(1):32– and reduced tensile strength. 36. doi:10.1055/s-2007-967745 Address: Hiroki Matsuura, MD, Department of General The authors report no relevant fi nancial relationships which, in the context Internal Medicine, Okayama City Hospital, 3-20-1, Omote-cho, of their contributions, could be perceived as a potential confl ict of interest. Kitanagase, Okayama-city, Okayama, 700-0962, Japan; doi:10.3949/ccjm.87a.20009 [email protected]

CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 87 • NUMBER 12 DECEMBER 2020 717

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