, Jillian W. Wong2 and John Koo3
(1)
Department of Dermatology, University of New Mexico, Albuquerque, NM, USA
(2)
Department of Dermatology, University of California, Davis Sacramento, CA, USA
(3)
Department of Dermatology, University of California, San Francisco, CA, USA
Abstract
Tracy is a well-appearing 16 year-old African American girl, who was brought to the dermatology clinic by her parents for gradual hair loss on the scalp. Physical exam revealed three asymmetric, incompletely hairless patches with irregular borders near the anterior hairline, to the right of the vertex, and near the left posterior hairline. The random distribution was bizarre enough to raise suspicion for self-induced alopecia. During the interview, the parents of the teenage girl were doing all of the talking with her staying quiet and wearing a countenance of resentment. When you asked her directly about possible hair-pulling behavior, she responded with a curt “no” and refused to elaborate further on her response. At one point she explicitly stated that she resented her parents for making her come to this visit. Her past medical history was otherwise unremarkable.
Tracy is a well-appearing 16 year-old African American girl, who was brought to the dermatology clinic by her parents for gradual hair loss on the scalp. Physical exam revealed three asymmetric, incompletely hairless patches with irregular borders near the anterior hairline, to the right of the vertex, and near the left posterior hairline. The random distribution was bizarre enough to raise suspicion for self-induced alopecia. During the interview, the parents of the teenage girl were doing all of the talking with her staying quiet and wearing a countenance of resentment. When you asked her directly about possible hair-pulling behavior, she responded with a curt “no” and refused to elaborate further on her response. At one point she explicitly stated that she resented her parents for making her come to this visit. Her past medical history was otherwise unremarkable.
Next, you politely asked the parents to leave the room and wait outside. During this short period of more personal, private interaction, she revealed to the practitioner that she had indeed been pulling her hair. As such, a diagnosis of trichotillomania was made. Tracy agreed to follow up with you regularly and individually. Once the parents were brought back into the room, you earnestly explained to them the need to see the patient one on one during future visits, and they cheerfully accepted such suggestion. Throughout a series of subsequent visits, she changed from being suspicious and reticent with you at first to ultimately volunteering information about her hair-pulling behavior and other aspects of her personal life.
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