Clinical Review Lesson of the week

Child abuse and trichotillomania

BMJ 2005; 330 doi: (Published 06 January 2005) Cite this as: BMJ 2005;330:83
  1. A Saraswat, assistant professor (
  1. 1 Department of Dermatology, Era's Lucknow Medical College and Hospital, Lucknow 226 016, India
  • Accepted 8 September 2004


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.

Embedded Image

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.

Case report

A 12 year old boy was referred by his family physician to the dermatology outpatient department with a complaint of partial hair loss on his scalp that was noticed one week before. On examination, there were two patches of partial alopecia on the temporovertical scalp measuring 2 cm by 2 cm and 3 cm by 3 cm. The …

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