Extensive Tonsure Pattern Trichotillomania-Trichoscopy and Histopathology Aid to the Diagnosis
A 24-year-old para-2 postpartum female was referred to dermatology OPD for diffuse alopecia of scalp. The patient's mother gave history of hair pulling by the patient. The patient developed hair pulling behavior following an incident of molestation when she was 15-years old. Though the alopecia was patchy initially, there was aggravation during both pregnancies leading to extensive tonsure pattern alopecia. She used to pull her hair both with hands and tweezers especially during leisure time. She was married for 4 years and had two children. There was no history of familial disharmony or of any significant illness in the patient. The general and systemic examinations revealed no abnormality except for pallor. On cutaneous examination, there was diffuse nonscarring alopecia of the scalp with varying length of hair in some areas [Figure and ]. There was sparing of hair on the scalp margin. The KOH mount for fungus was negative. The blood tests like complete blood count, liver function test, renal function test, and thyroid profile were normal except for low hemoglobin. Trichoscopy showed scanty hairs with varying length, few broken hair, trichoptilosis, coiled hair, and black dots []. The histopathology showed empty hair follicles, disrupted follicles with pigment casts, and no inflammation, confirming the diagnosis of trichotillomania []. The patient was referred to psychiatry OPD for further management.