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| Fig. 20.4 Trichotillomania. The highly irregular shape, sharp circumscription, and presence of 'broken off' hairs of various lengths are typical of this condition. |
The typical patient is an adolescent girl, although the condition can affect children of both sexes as well as adults. In trichotillomania, hairs are forcibly plucked out of the scalp by the patient, usually as a mechanism for relieving tension or stress. Less often, trichotillomania is a manifestation of psychosis or an obsessive-compulsive neurosis. Although the patient may deny plucking, the often bizarre shape of the bald area, combined with the presence of short hairs of various lengths within the area of thinning, suggest the diagnosis (Fig. 20-4). The diagnosis may be confirmed by a scalp biopsy demonstrating diagnostic features, or by creating a “hair growth window.” This test is performed by weekly shaving of an involved area to prevent plucking; the hair will recover and regain normal density within the shaved area, resembling a “five o’clock shadow.”
Buescher L, Resch D: The biopsychosocial aspects of hair disease. In McMichael A, Hordinsky M, editors: Hair and scalp diseases, New York, 2008, Informa Healthcare, pp 267–275.
Tay YK, Levy ML, Metry DW: Trichotillomania in childhood: case series and review, Pediatrics 113(5):e494–e498, 2004.
