Trichotillomania Masked by Diffuse Alopecia Areata: A Case Report

An 11-year-old girl with a history of tinea capitis presented with a 3-month history of decreasing hair density. Initial diagnosis was diffuse alopecia areata, based on trichoscopic findings and histopathology. After treatment with methylprednisolone, the patient showed increased hair density, but admitted to occasional hair pulling. Further trichoscopy and a second biopsy revealed signs consistent with trichotillomania, a condition where a person feels compelled to pull out their hair. This case highlights the uncommon co-existence of alopecia areata and trichotillomania, and emphasizes the importance of trichoscopy in differentiating hair disorders with similar presentations.