Extensive Tonsure Pattern Trichotillomania-Trichoscopy and Histopathology Aid to the Diagnosis
A 19-year-old female presented in dermatology outpatient department (OPD) with diffuse alopecia of scalp for 4 years. The alopecia started from frontal scalp 4-years back, which gradually extended to involve the entire scalp leaving behind the margins. On direct questioning, the mother gave history of repeated hair pulling behavior of the patient. She used to pull hair mostly during study hours at home. The patient was anxious and had a guilt feeling for her hair loss. There was no obvious stress in the family. The general and systemic examination revealed no abnormality except pallor. The cutaneous examination showed diffuse alopecia of scalp with varying length of remaining few hairs. The alopecia involved the entire scalp sparing only the occiput and margins of scalp resembling tonsure pattern [Figure and ]. There were few follicular papules distributed sparsely on the scalp. There was no alopecia involving other body hair. The KOH mount for fungus was negative. The blood tests like complete blood count, liver function test, renal function test, and thyroid profile were within normal limits except for low hemoglobin. The trichoscopy showed broken hair of varying length, coiled hair, and black dots []. The histopathological examination showed disrupted hair follicles and pigment casts without any inflammation []. With the aid of trichoscopy and histopathology, the diagnosis of extensive tonsure pattern trichotillomania with pseudofolliculitis was made. The patient was referred to psychiatry OPD for further management.