Familial Trichotillomania in Three Generations
A 13-year-old male presented with 1-year history of focal hair loss in the mid-frontal scalp. He was previously treated with local steroids for presumed alopecia areata, with no improvement. Examination revealed a patchy area of hair loss, with several short broken hairs of varying lengths []. On dermoscopy examination of the scalp, we found the typical features of TTM, including short hairs with trichoptilosis, broken hair (different lengths) and black dots []. Additionally, traumatic bleeding was evident. Histological examination showed trichomalacia with irregularly shaped hair follicles and melanin pigment casts [Figure and ]. Upon further questioning, the father admitted repeated pulling of his beard hairs since puberty, with mild-to-moderate severity of symptoms. The 60-year-old paternal grandfather also suffers from severe recurrent hair pulling of his beard since puberty, which sometimes precludes him from leaving home.