ABSTRACT
Trichotillomania is an impulse control disorder characterized by repetitive self-pulling of hair, usually from the scalp, eyebrows, eyelashes, and/or other body areas, which results in hair loss. The clinical aspect of trichotillomania is variable. Classically, it is characterized by single or multiple, ill-defined patches of incomplete alopecia displaying short and broken hairs of varying lengths. However, in some cases the alopecic patches may be well-delimited simulating alopecia areata, whereas in other cases hair pulling may determine diffuse alopecia. Histopathology is rarely performed in trichotillomania. The most frequent findings are catagen and telogen hairs without evidence of inflammation associated with empty anagen follicles. The diagnosis of trichotillomania is often challenging and is mainly based on history and clinical examination. Dermoscopy is very useful in doubtful cases. Trichotillomania is very difficult to treat because of the psychological stress behind it. Trichotillomania may result in prominent hair loss and significant distress and/or functional impairment.
