Images in Dermatology: Trichotillomania in an Elderly Indian Woman

Volume 3 Issue 1 (Jul-Dec) 2025 Images in Dermatology (1) Articles in The ESRF Research Journal for Undergraduate Medical Students are Open Access articles published under a Creative Commons Attribution-Non Commercial 4.0 International License (CC BY-NC). This license permits use, distribution, and reproduction in any medium, provided the original work is properly cited, but it cannot be used for commercial purposes and it cannot be changed in any way. Published by: Eureka Scientech Research Foundation, Kolkata. Online access: https://esrfrjums.co.in Images in Dermatology: Trichotillomania in an Elderly Indian Woman DOI: 10.5281/ zenodo.17360510 Available from: https:// esrfrjums.co.in/index.php/main/ article/view/81 Adityendu Chakraborty1, Arun Achar2. Monika Kumari1 1Post Graduate Trainee, Dermatology, Nil Ratan Sircar Medical College, Kolkata 2Professor and Head, Dermatology, Nil Ratan Sircar Medical College, Kolkata CASE 1 A 61-year-old female attended the dermatology outpatient department with a 2-year history of progressive hair loss over the scalp. She noticed patchy areas of hair loss on the scalp with no associated pruritus, pain, or skin inflammation. On probing, patient revealed episodes of hair pulling, mostly unconsciously, often preceded by feelings of tension or anxiety. She also expressed feelings of guilt and embarrassment about her hair loss and hair pulling behaviour. Local examination revealed multiple irregular, patchy areas of hair loss with broken, short hairs of varying lengths, predominantly over the vertex region. The scalp appeared normal with no signs of inflammation, scaling, or erythema. The hair pull test was negative. Dermoscopy revealed numerous short, broken hairs, black dots, coiled hairs, and hairs of different lengths, hair powder and v-hairs. There was absence of exclamation point hairs and yellow dots, typical of Alopecia areata. A psychiatric assessment showed features of moderate depression and anxiety. The patient was diagnosed as a case of trichotillomania (ICD-10 code F63.3) and started on cognitive -behavioral therapy (CBT) with Habit Reversal Training (HRT), antidepressant (escitalopram 10 mg daily) and an anxiolytic (clonazepam 0.5 mg at night). At 3-month follow-up, the patient reported a reduction in hair pulling episodes and improvement in scalp appearance. Dermoscopic examination showed decreased black dots and more hairs in the anagen phase Corresponding Author Dr. Adityendu Chakraborty Room number 16A, NHQ Doctor’s hostel, Nil Ratan Sircar Medical College, Kolkata—14 E-mail: adityenduchakrabort- [email protected]m Figure 1: Clinical image showing patchy hair loss with irregular borders over the scalp. Figure 2: Dermoscopic image demonstrating coiled hair (red arrow), flame hair (blue arrow), v -hair (green arrow) and black dot (pink arrow). Volume 3, Issue 1 (Jul-Dec), 2025 (2) Articles in The ESRF Research Journal for Undergraduate Medical Students are Open Access articles published under a Creative Commons Attribution-Non Commercial 4.0 International License (CC BY-NC). This license permits use, distribution, and reproduction in any medium, provided the original work is properly cited, but it cannot be used for commercial purposes and it cannot be changed in any way. Images in Dermatology Figure 3: Dermoscopic image demonstrating hair powder (red arrow). Declaration of patient consent: Appropriate patient consent was obtained by the authors for taking and sharing pictures. Trichotillomania in an Elderly Indian Woman