The Friar Tuck Sign in Trichotillomania

The document reports a case of an 8-year-old male patient diagnosed with trichotillomania (TTM), an impulse-control disorder characterized by the chronic pulling of hair from the scalp and other sites. The patient presented with a bald patch on the scalp in a classical tonsure pattern, known as the "Friar Tuck" sign, which did not respond to antifungal treatments. Trichoscopy confirmed the diagnosis, revealing decreased hair density, broken hairs of varying lengths, black dots, signs of hemorrhage, and an absence of exclamation mark hairs. The patient's condition was suggested to be triggered by familial stress, including his parents' divorce. He was referred for cognitive-behavioral therapy with a child psychiatrist. The document emphasizes the importance of differentiating TTM from other forms of hair loss, such as alopecia areata, androgenetic alopecia, and tinea capitis, and highlights the utility of trichoscopy in improving diagnostic accuracy. Treatment options for TTM vary based on the age of onset and may include cognitive-behavioral therapy and psychopharmacological interventions.