Visual Diagnosis: The Case of the Balding Preschooler

In a case study from 2017, a 4-year-old girl presented with hair loss without any associated symptoms or relevant medical history, except for a maternal uncle with alopecia areata. Examination revealed a patch of hair thinning with normal scalp skin and negative hair pull test, while trichoscopy showed broken hairs. The diagnosis was early-onset trichotillomania (TTM), a hair-pulling disorder typically starting at age 11 to 13, but in this case presenting earlier. TTM has a lifetime prevalence of 0.6% to 4.0%. The girl's treatment involved behavioral interventions and discontinuing clobetasol cream. After 3 months, her hair pulling had decreased and hair regrowth was observed. The case highlights that TTM is diagnosed clinically and that early-onset TTM can be effectively managed with behavioral strategies.