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Trichotillomania: a cry for help
  1. Vania Oliveira Carvalho1,2,
  2. Kerstin Abagge1,
  3. Leide Parolin Marinoni1,
  4. Betina Werner3
  1. 1
    Federal University Of Parana, Curitiba, 80060090, Brazil
  2. 2
    Rua Richard Strauss 62, Parna, 80820110, Brazil
  3. 3
    Federal University of Parana, Pathology, Curitiba, 80060090, Brazil
  1. rcarvalho50{at}

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A 12-year-old boy presented with a 6 month history of loss of eyelashes and eyebrows and a patch of incomplete alopecia in the occipital area. For a year he had been showing a low level of interest in his school activities according to his mother, although he complained that “she’s not present to say that”. There was no history of previous disease and his weight and height were within normal values.

At physical examination, hair was scarce in the occipital area (fig 1) and there was alopecia of the eyelashes and eyebrows with new growing hair (fig 2). The skin biopsy of the eyebrow confirmed trichotillomania.

Figure 1 Area of alopecia with hairs of varying length.
Figure 2 Eyebrow with hairs of varying length and partial loss of the eyelashes with dark growing hair shafts.

Trichotillomania is a traction alopecia that results from a compulsive habit produced consciously or subconsciously. It occurs more frequently in children under 5 years of age and young adolescents. Young children often have a self limited course of hair pulling; pre-adolescents to young adults may benefit the most from active intervention, such as increasing awareness of hair pulling behaviour and behaviour modification training.1,2 The most common site is the scalp, but eyelashes may also be affected and may be mistaken for alopecia areata.3

The main differential diagnosis is alopecia areata, and the presence of various growing shafts in the tarsal region and different hair lengths over the scalp contribute to the clinical diagnosis. Psychological aspects must always be evaluated in patients with this condition.1 The clinical manifestation that brings the patient to consultation represents only the top of the iceberg as a “cry for help”.



  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication