Clinical features Hair pulling sites

Scalp hair is pulled out in approximately 80 per cent of cases, resulting in diverse patterns of bald patches and/or hair thinning. (3) One pattern of hair loss, tonsure (£!£ 1), is characterized by a circular denuded patch over the top of the scalp.

Fig. 1 Tonsure pattern of hair loss in trichotillomania.

Most patients pull from multiple hair sites. The most common sites, in descending order of frequency, are the scalp, eyelashes, eyebrows, pubis, face, and the extremities.(4) Rarely, hair is additionally pulled from spouses, children, or pets. Children may pull hair from dolls. (3)

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