A 12 year old girl presented with  a large, irregular area of hair loss over the central frontoparietal scalp. Physical examination reveals scattered short hairs of varying lengths and a few small crusts throughout the area of alopecia. The remainder of the scalp appears normal.

Images from “Patchy hair loss on the scalp. Helm MF” Cleveland Clinic Journal of Med

Trichotillomania, is the compulsive pulling out of one’s own hair. Irregularly shaped areas of alopecia containing short hairs of varied lengths and excoriation should raise clinical suspicion of trichotillomania. Biopsy can confirm the diagnosis when follicles devoid of hair shafts, hemorrhage, and misshapen fragments of scalp hair (pigment casts) are seen. (from Cleveland Clinic Journal of Medicine[link])

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