Eyebrow and eyelash loss (madarosis)

Brow and lash follicles spend a much shorter share of their cycle in the growing phase than scalp follicles do, so they are hit later in a course of chemotherapy and often only partly. Losing them changes the face more than the loss of scalp hair does, and it removes a mechanical defence: without lashes the eye collects dust and grit, and without brows sweat runs into the eyes. Practical measures are wraparound glasses outdoors, preservative-free artificial tears, and brow pencils, powders and stencils, which the Look Good Feel Better workshops teach free of charge. Bimatoprost, a prostaglandin analogue drop approved for thin lashes, has randomised evidence including a cohort who had finished chemotherapy; eyebrow use is off-label and less well studied. Semi-permanent tattooing and microblading of brows are usually deferred until blood counts have recovered and done by a practitioner told about the treatment, because of infection risk. A separate and opposite problem belongs here: epidermal growth factor receptor inhibitors such as erlotinib and osimertinib can make eyelashes grow abnormally long and stiff (trichomegaly) so that they scratch the eye, which an optometrist or ophthalmologist trims.