Trichotillomania

Abstract

Tracy is a well-appearing 16 year-old African American girl, who was brought to the dermatology clinic by her parents for gradual hair loss on the scalp. Physical exam revealed three asymmetric, incompletely hairless patches with irregular borders near the anterior hairline, to the right of the vertex, and near the left posterior hairline. The random distribution was bizarre enough to raise suspicion for self-induced alopecia. During the interview, the parents of the teenage girl were doing all of the talking with her staying quiet and wearing a countenance of resentment. When you asked her directly about possible hair-pulling behavior, she responded with a curt “no” and refused to elaborate further on her response. At one point she explicitly stated that she resented her parents for making her come to this visit. Her past medical history was otherwise unremarkable.