Trichotillomania (hair pulling mania) may present as unexplained baldness in a patient.


The condition may affect any age from 12 months to old age. Males may predominate in young children but afterwards females constitute the majority.


Clinical features:

(1) The patient shows hair loss that may involve any part of the body, but usually includes the scalp.

(2) The patient often denies the habit and may actively avoid contact with health care providers.

(3) The patient may find it difficult to resist the practice, feeling an increasing tension if unable to pull on the hair.

(4) Patients may have psychological complaints with depression, anxiety, obsessive-compulsive neuroses, eating disorders and phobias common. Episodes of hair pulling may increase during times of personal stress.

(5) Disfigurement may result in feelings of isolation and shame.


Clinical patterns:

(1) binge pullers (pull a large amount of hair in a short period of time, often associated with stressful events)

(2) unaware of habit (pull at, suck on or twist as an unconscious habit)


Clinical findings:

(1) The distribution of hair loss is uneven with hairs of uneven lengths.

(2) The patient may wear a wig.

(3) The patient may wear false eyelashes or penciled-in eyebrows.

(4) Some patients may show evidence of skin picking.

(5) There may be uneven distribution of gray hair in an older patient.

(6) Patients who swallow the hair may develop gastric trichobezoars.

(7) The skin in affected areas is not inflamed, scarred or scaling.

(8) Affected areas may show normally growing hairs, empty follicles, and broken hairs.

(9) An affected area that is covered with an occlusive dressing will show normal hair regrowth.

(10) No other explanation (drugs, fungal infection, autoimmune disease, atopy, etc.) is identified.


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