Diagnosis: Trichotelamania

This diagnosis of Trichotelamania is made with a hand microscope, which shows how the hairs are actually broken as they come out of the scalp. Trichotillomania is an obsessive-compulsive disorder in which a person picks out their hair. As you can see from the patient’s photo, the hair loss is not in a particular known pattern, which alerts the doctor that the diagnosis is not genetic balding. These cases can be transplanted; however, unless the underlying obsessive disorder is fixed, the patient will pull out the hair-transplanted grafts to the same fate. I rarely perform surgery on these patients, even when they swear that the picking problem has been solved.