Why does hair pulling disorder cause bald patches?

Hair pulling disorder, also called trichotillomania, involves repeated urges to pull out hair. Pulling may happen consciously or during concentration, stress, boredom, or relaxation. Because individual hairs are removed at different times, the affected area can look irregular rather than smoothly shaped. Broken hairs, short stubble, redness, scabs, or hairs of mixed lengths may be present.

The skin can become sore from repeated handling, and forceful pulling may irritate follicles. A clinician may examine the patch and ask about urges, rituals, triggers, and attempts to stop. Ring-shaped scaling or a completely smooth patch can point toward other causes, so appearance alone cannot settle the diagnosis.

Notice when and where pulling happens, and keep nails and hands occupied during those moments. A soft head covering, fidget object, or barrier around a frequently touched area may reduce automatic pulling. Avoid blaming yourself; the urge can be difficult to control without support. Dermatology care can address the scalp, while a mental health professional familiar with habit-reversal approaches can help with triggers and replacement behaviours.

Arrange medical care for bleeding, pus, spreading redness, significant pain, or repeated picking of damaged skin. Seek assessment when a patch enlarges, does not show regrowth, or has scaling, because infection, inflammation, and other hair disorders can resemble pulling-related loss. Urgent help is needed after swallowing hair or when there is severe abdominal pain or vomiting.

Does the patch pattern fit hair pulling disorder? Could infection or another scalp condition be involved? How can I protect irritated skin? Which behavioural treatment may help with urges? Should I seek support for hair ingestion or related repetitive behaviours?