A Case of Trichotillomania Presenting as a Factitious Ulcer

A 30-year-old female with a 6-month history of a scalp ulcer was initially misdiagnosed with pediculosis capitis. Upon further examination, including a scalp biopsy and trichoscopy, trichotillomania was diagnosed. The patient exhibited moderate anxiety and depression and acknowledged hair-pulling behavior. Treatment included clomipramine, N-acetyl cysteine, and habit reversal training. This case highlights the importance of thorough patient interviews to identify self-inflicted hair loss, as patients often do not report such behaviors to psychiatrists initially.