10-Year-Old Female with an Irregularly Shaped Patch of Hair Loss

Trichotillomania is a type of alopecia characterized by repeated hair pulling, resulting in irregular, patchy hair loss. The condition's pathophysiology is not fully understood, but it appears to have a genetic component, with the HOXB8 and SAPAP3 genes potentially playing a role. Trichotillomania may present with trichophagia, leading to trichobezoars in severe cases, and is often associated with psychiatric comorbidities such as depression, anxiety, substance use disorder, and obsessive-compulsive disorder. Treatment addresses the psychological triggers of hair-pulling behaviors and varies based on the patient’s age. In pre-school children, the condition is likely to self-resolve, while in school-aged children, behavioral therapy is more effective than pharmacologic therapy. In adolescents and adults, combination therapy utilizing pharmacotherapy, psychotherapy, and management of comorbid psychiatric disorders suggests the highest clinical efficacy. Emerging treatment options include the antioxidant milk thistle, probiotics, and inositol, though evidence of their clinical benefit is limited.