Visual Diagnosis

Case: A 9-year-old girl presents with progressive hair loss for several months. The hair loss is always at the same spot on the scalp.

Diagnosis:

This patient has trichotillomania.

Trichotillomania, a hair pulling disorder, is often associated with anxiety, depression, or stress. The disorder is part of the obsessive-compulsive spectrum. The scalp is the most common area, followed by eyebrows, eyelashes, and hair on extremities. The hair in the affected area may vary in length. Children often outgrow the disorder, whereas adults may benefit from behavior modification. Often, treatment of any underlying psychiatric disorder may resolve the hair pulling.

Clinical Practice Pearls:

• Scaling around the skin is not often found in areas of pulled hair. Therefore, another etiology should be considered.
• Consider other psychiatric comorbidities when diagnosing trichotillomania.

Futher Reading:

• Huynh M, Gavino AC, Magid M. Trichotillomania. Semin Cutan Med Surg. 2013. 32(2):88-94.