Figure 1

Self-induced (neurotic) compulsive hair pulling/plucking.

Physical: Circumscribed area of alopecia with irregular borders and broken hairs of different length. May find scalp excoriations and perifollicular petechiae; usually only one area (frontoparietal or frontotemporal) affected. Eyebrows and eyelashes may also be plucked.

Investigations: Punch biopsy if unsure.

DDx: Alopecia areata, traction alopecia, tinea capitis.

Management

• When in doubt, biopsy confirms diagnosis.
• Ask about traumatic events (death, separation, school troubles)
• Difficult problem; look for precipitant; may need referral to psychiatry (psychotherapy, behavior therapy, SSRIs).
• Most children outgrow condition, but can be difficult to manage in adults.