Trichotillomania

Bald patches were noted on the head of a 40-year-old woman with longstanding mental illness. She claimed, “I have to pull out my hair, so my scalp won’t hurt.” The patient began pulling out her hair when she stopped taking her psychotropic medications 6 years earlier. Joe Monroe, PA-C, performed a biopsy of the scalp; findings included focal fibrotic changes in some of the hair follicles—a feature of trichotillomania.This condition is much more common in children (see CONSULTANT,July 2002, page 1027); affected adults have a poorer prognosis. Psychotherapy and a resumption of psychotropic medication were clearly indicated for this patient. Unfortunately, she refused treatment and was lost to follow-up.