|Year : 2000 | Volume
| Issue : 1 | Page : 41-42
AK Jaiswal, Rajesh Verma, Vivek Kumar, Vaishmpayan
A K Jaiswal
Source of Support: None, Conflict of Interest: None
An unusual case of tonsure trichotillomania is reported for its rarity and clinical interest
Keywords: Tonsure trichotillomania
|How to cite this article:|
Jaiswal A K, Verma R, Kumar V, Vaishmpayan. Tonsure trichotillomania. Indian J Dermatol Venereol Leprol 2000;66:41-2
| Introduction|| |
The term trichotillomania, describing a neurotic compulsion to pull out the hair was coined by Hallopeau in 1889 at a time when psychopathology was poorly understood . Of late some authors are of the opinion that it is an obsessive compulsive disorder. 
Infants and children are the common sufferers. Tonsure trichotillomania, usually seen in adolescent or adult females, is characterized by a cropped appearance of scalp over the crown extending to the frontal margin in some cases, but sparing the nape of the neck and lateral margins. Herein we report a case of such rare entity.
| Case Report|| |
A 16-year-old girl accompanied by her parents presented with diffuse loss of scalp hair of one year duration. As per the patient, the loss started from the vertex after an emotional shock (death in the family) and over a period of two months it extended
to involve whole of the scalp but sparing nape of the neck and lateral margins. The hair in the affected area had remained short and stubby as though it had stopped growing. She strongly denied pulling at her hair. The patient's mother also did not admit the possibility that the hairs were being deliberately pulled out. On examination the hairs over the affected area were 2-3 cms in length [Figure - 1]. Only the nape of the neck and a narrow zone at the margins of the scalp had hair of normal length. Under a magnifying glass most of the affected hair shafts had tapere hypopigmented ends of newly growing hairs.Psychiatric analysis revealed her to be having a chronic tension state due to inability to cope up with her studies. The patient was advised minor tranquilizers and psychotherapy but she failed to report for follow up.
| Discussion|| |
In 1970, Sanderson reported 8 cases, of trichotillomania of severe and unusual form presenting with an extensive area of scalp on which hairs were normal, but they looked as if they had been shaved a month or two before and in which the hair persisted at same length at subsequent examinations. They termed this entity as tonsure trichotillomania. Explanation given by authors for persistence of newly growing short anagen hair was the continual plucking of all those exceeding 3 cm length. In cases of trichotillomania usually no effort is made to conceal the hair pulling from others. However, most of the patients with tonsure variety persuade themselves and others that their characteristic pattern of hair loss is natural. The tonsural pattern may be determined by a higher threshold for pain in the centre of the scalp than at the margins. The case under report has all the features of tonsure trichotillomania.
| References|| |
|1.||Hallopeau H. Alopecie par Gratage (Trichomanieen trichotillomania). Annls Derm Syph 1889 ; 10: 440. |
|2.||Mc Elroy SL, Philips KA. Obsessive compulsive spectrum disorder. J Clin Psychiatry 1994;55: 33-51. |
|3.||Sanderson KV, Hall -Smith P. Tonsuure trichotillomania. Br J Dermatol 1970; 82: 343. |
[Figure - 1]