Common features:
(1) obsessive-compulsive personality
(2) current stress
(3) persistent hairs in areas difficult to reach
(4) presence of other hair compulsions such as trichotillomania (hair pulling), trichoteiromania (compulsive hair rubbing) or trichodaganomania (hair biting)
(5) exclusion of other causes of alopecia
The patient examination may show:
(1) negative hair pull test
(2) persistent hair in other body areas
(3) hair stubs in hair follicles with hair showing cut ends
(4) normal appearing scalp
(5) normal scalp biopsy
Barriers to diagnosis:
(1) denial by the patient or resistance to the diagnosis
(2) failure to examine hairs carefully
Differential diagnosis:
(1) alopecia areata
