What should you know about dermoscopy of trichotillomania?

During the examination, a dermatoscope provides a close view of the scalp surface, hair shafts, and follicle openings. Hair pulling can leave hairs at different lengths, broken shafts, tapered regrowth, and areas where the scalp has been repeatedly disturbed. The clinician considers these findings alongside the distribution of the bald patches, the history of urges or pulling, and the condition of the skin. Similar hair changes can occur in other disorders, so dermoscopy is supportive rather than a stand-alone diagnosis.

Before the appointment, note when the hair loss began, where your hands tend to pull, whether it happens during stress or concentration, and any scalp products or treatments you use. Avoid hiding the area with fibres or heavy styling products on the day if possible. Be open about pulling, even if it feels embarrassing; this helps the clinician distinguish a hair-pulling pattern from infection, inflammation, or another form of alopecia. Care may involve dermatology and mental-health support, with strategies aimed at reducing urges and protecting regrowth.

Arrange an assessment for new or expanding bald patches, scalp pain, marked redness, scaling, pus, bleeding, or broken skin. Seek earlier care when eyelashes or eyebrows are being pulled, when hair loss is spreading quickly, or when pulling feels difficult to control. Open sores can become irritated or infected, while prolonged traction or repeated injury may affect regrowth. A dermatologist can examine the scalp and decide whether additional testing is needed.

Ask which dermoscopic signs support hair pulling, what other causes of bald patches should be excluded, and whether the follicles appear capable of regrowth. Ask who can help with urge-management techniques and how you should care for irritated scalp skin.