Introduction

A 12 year old boy presented with two patches of hair loss on his scalp (figure). A clinical and histopathological diagnosis of trichotillomania was made. On follow up after taking a detailed history, the boy revealed that the hair was being pulled by an abusive teacher during tuition after school. I found two more children similarly abused by the teacher. I discuss the importance of this under-recognised pattern of child abuse and its similarity to trichotillomania.

Localised patch of hair loss on the scalp

Child abuse has varied manifestations. Physical abuse of a child often results in identifiable dermatological signs, which can pinpoint the diagnosis. Abuse can closely resemble other dermatoses, however, resulting in diagnostic errors.

Trichotillomania is a condition currently classified as an impulse control disorder, which is characterised by repetitive pulling of one's own hair resulting in alopecia.