ArticlePDF Available

Trichoscopic Features of Eyebrow Trichotillomania: It Looks Similar to Scalp Trichotillomania

Authors:
A Tülin Güleç
A Tülin Güleç
A Tülin Güleç
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Download full-text PDF
Read full-text
Download citation

Figures

Figures - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Available via license: CC BY
Content may be subject to copyright.
Letter | Dermatol Pract Concept 2020;10(2):e2020040 1
Dermatology
Practical & Conceptual
Introduction
Trichotillomania is a self-induced hair loss originating from
pulling of one’s own hair repetitively in a compulsive manner,
leading to significant hair loss. Although scalp hair is the
most common site of involvement, it is also reported in other
hair-bearing areas of the body such as eyelashes, eyebrows,
and beard. Trichoscopic criteria have been well described
for scalp trichotillomania including mainly broken hairs at
different lengths, short hairs with trichoptilosis, coiled hairs,
hook hairs, tulip hairs, flame hairs, and V-sign [1]. Yet, to
our knowledge there are no data regarding the trichoscopic
features of this alopecia on eyebrows.
Case Presentation
A 40-year-old man presented with a years-long history of
numerous nevi. While he was being examined by a com-
puterized polarized light videodermatoscope (FotoFinder
Dermoscope; TeachScreen Software GmbH, Bad Birnbach,
Germany), almost complete loss of his eyebrows was noticed.
Dermatological examination showed a few hairs on the
lateral sides, while there were just black dots and some bro-
ken hairs on the remaining part of the eyebrows (Figure 1).
Trichoscopic examination revealed various findings, namely
broken hairs at different lengths, coiled hairs, hook hairs,
short hairs with trichoptilosis, V-sign, flame hairs, tulip
hairs, black dots, and a few yellow dots (Figure 2, A and B).
After we took a careful history, he reported that he had been
pulling out his eyebrow hairs during stressful times for the
past 4 years.
Conclusions
The main clinical differential diagnosis of trichotillomania is
patchy alopecia areata. However, it creates a diagnostic chal-
Trichoscopic Features of Eyebrow Trichotillomania:
It Looks Similar to Scalp Trichotillomania
A. Tülin Güleç1
1 Department of Dermatology and Venereology, Başkent University Faculty of Medicine, Ankara, Turkey
Key words: eyebrow, trichoscopy, trichotillomania, dermoscopy
Citation: Güleç AT. Trichoscopic features of eyebrow trichotillomania: it looks similar to scalp trichotillomania. Dermatol Pract Concept.
2020;10(2):e2020040. DOI: https://doi.org/10.5826/dpc.1002a40
Accepted: December 11, 2019; Published: April 3, 2020
Copyright: ©2020 Güleç. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: None.
Competing interests: The author has no conflicts of interest to disclose.
Authorship: The author takes responsibility for this publication.
Corresponding author: Prof. Dr. A. Tülin Güleç, Başkent University Faculty of Medicine, Department of Dermatology and Venereology,
Mareşal Fevzi Çakmak Cad., 53. sokak, No:48, kat: 4, Bahçelievler, Ankara, Turkey. Email: tulinogulec@hotmail.com
Figure 1. Eyebrow trichotillomania. Almost complete loss of eye-
brows with a few hairs on the lateral sides, and black dots with some
broken hairs on the remaining main part.
2 Letter | Dermatol Pract Concept 2020;10(2):e2020040
trichoscopic features of scalp trichotillomania and confirmed
it by the appropriate history. Consequently, we suggest that
trichoscopy is also beneficial for the clinical diagnosis of
eyebrow trichotillomania.
References
1. Martin JM, Montesinos E, Cordero P, Gonzalez V,Ramon D.
Trichoscopic features of trichotillomania. Pediatr Dermatol.
2019;36(2):265-267.
2. Velez N, Khera P, English JC 3rd. Eyebrow loss: clinical review. Am
J Clin Dermatol. 2007;8(6):337-346.
lenge in particular when it occurs on a body site other than
the scalp, and/or if the patient denies the habit of hair pulling.
Besides, eyebrow alopecia may be secondary to numerous
causes such as hypothyroidism, chemotherapy, secondary
syphilis, leprosy, and frontal fibrosing alopecia in addition to
alopecia areata [2]. Furthermore, trichoscopic findings are not
necessarily identical in alopecias that can involve both scalp
and eyebrow hairs, as in frontal fibrosing alopecia. It presents
red or gray dots on the eyebrow area, while loss of follicular
openings, perifollicular erythema, and scaling are the main
features on the frontal scalp. Yet, in the present case, we could
easily diagnose trichotillomania when we observed identical
Figure 2. Trichoscopic features of eyebrow trichotillomania. (A) Black dots (red arrows), broken hairs at different lengths (green arrows),
yellow dot (orange arrow), hook hair (blue arrow), tulip hairs (yellow arrow), V-sign (purple arrow). (B) Broken hairs at different lengths
(green arrows), hook hair (blue arrow), flame hair (red star), tulip hair (yellow arrow), V-sign (purple arrow), yellow dot (orange arrow),
short hairs with trichoptilosis (blue stars), black dot (red arrow) (original magnifications: A,B, ×20).
... Multiple-drug therapy with dapsone, rifampin, and clofazimine can be used to treat leprosy, but eyebrow regrowth is exceptional [50] Tinea faciei/blepharo-ciliaris Pink to red scaly, inflammatory patches and plaques over eyebrows Itchy erythematous patch involving the eyelid and broken eyelash hairs [57] Comma hairs, corkscrew hairs, bent hairs, morse code hairs, zigzag hairs [56] Scaling, broken hairs, bent hairs, and morse code hairs [57] Topical antifungals ± oral terbinafine or oral itraconazole (case report) [57] Trichotillomania Isolated eyebrow hair loss without erythema Isolated alopecia only upper or lower eyelashes rather than both [74] Black dots, broken hairs at different lengths, hook hairs, tulip hairs, and the V sign [73] Broken hairs of different length, especially in the longer eyelashes [72,74] Psychotherapy [105] least 50% eyebrow loss in the absence of AA accounts for 1 point, whereas a positive biopsy of the affected anterior or temporal scalp or eyebrow contributes 2 points toward the diagnosis (Table 1) [37]. Localized scleroderma is a disorder of excessive collagen deposition that can present as unilateral atrophy of the frontoparietal region above the eyebrow. ...
... Eyebrow and/or eyelash hairs may be nonuniform, tufted, or tortuous, and hair follicles may be prominently visible [72]. Trichoscopy shows broken hairs of different lengths, black dots, hook hairs, tulip hairs, and the V sign [73]. Eyelash alopecia is typically limited to the longer eyelashes of the upper eyelid [72,74]. ...
Eyebrow and Eyelash Alopecia: A Clinical Review
Article
Full-text available
  • Oct 2022
  • AM J CLIN DERMATOL
Madarosis is characterized by either complete or partial loss of eyebrow or eyelash hair. Etiologies for madarosis are varied, and accurate diagnosis is the first step in clinical management. Many studies have described findings related to specific causes of madarosis, but few have summarized the collective literature. The purpose of this review is to provide an updated overview on the symptomatology, diagnosis, trichoscopy findings, and treatment of eyebrow and eyelash alopecia.
View
... Trichotillomania is characterized by pulling one's own hair repetitively in a compulsive manner. 2 It is classified inside G. Atış, A.Ş. Sarı, P. Güneş et al. the obsessive-compulsive disorder and related disorders in the Diagnostic and Statistical Manual of Mental Disorder-Fifth Edition (DSM-5). 3 Before pulling their hair out, patients experience anxiety; and feel relaxed thereafter. ...
... It rarely represents isolated eyebrow involvement 1 and may rarely appear as an initial finding of AA. 5 Although trichoscopic features of TTM on the scalp were well described, trichoscopy of eyebrow TTM were discussed in limited reports. 2 On trichoscopy of eyebrows, the authors observed hairs with different lengths, split hair, question mark hair, broken hair, flame hair, comma hair, tulip hairs, black dots, hyperpigmented and hemorrhagic areas on the surface. Yellow dots are one of the common features in AA and show a regular distribution, 6 but rare in TTM, and the distribution is irregular. ...
Isolated hair loss on the eyebrow: five cases with trichoscopic features
Article
Full-text available
  • Mar 2022
Abstract Alopecia areta (AA) and trichotillomania (TTM) are common causes for hair loss on the eyebrows. Yellow dots, vellus hairs, anisotrichosis, empty follicular openings, and black dots were observed in the present study’s patients with AA. Split hairs, question mark hairs, broken hairs, flame hairs, black dots, hairs with different lengths, and hemorrhagic areas were found in the patients with TTM. Trichoscopy is a very useful and helpful technic in distinguishing AA and TTM on the eyebrows.
View
... Trichotillomania may affect any site of the body (32). According to available case reports, trichoscopic features of eyebrows and scalp trichotillomania are similar, and include: irregularly broken hairs, black dots, coiled hairs, hook hairs, trichoptilosis, v-sign, flame hairs, tulip hairs, yellow dots, and haemorrhages (33,34). Trichoscopy of eyelashes trichotillomania presents irregularly broken hairs, black dots, and flame hairs (35). ...
... These findings were similar to features found in the scalp and included irregularly broken hairs, black dots, coiled hairs, hook hairs, trichoptilosis, v-sign, flame hairs, tulip hairs, yellow dots, and various areas of haemorrhages. Güleç et al. (33) described the v-sign in eyebrow trichotillomania. However, eyebrow hairs grow in one-hair follicular units. ...
Diagnostic Accuracy of Trichoscopy in Trichotillomania: A Systematic Review
Article
Full-text available
  • Jun 2021
  • ACTA DERM-VENEREOL
Trichotillomania is classified as a mental health disorder, but it is commonly diagnosed by dermatologists. The aim of this systematic review is to assess the diagnostic value of trichoscopy in diagnosing trichotillomania. The analysis identified the 7 most specific trichoscopy features in trichotillomania. These features had the following prevalence and specificity: trichoptilosis (57.5%; 73/127 and 97.5%, respectively), v-sign (50.4%; 63/125 and 99%), hook hairs (43.1%; 28/65 and 100%), flame hairs (37.1%; 52/140 and 96.5%), coiled hairs (36.8%; 46/125 and 99.6%), tulip hairs (36.4%; 28/77 and 89.6%), and hair powder (35.6%; 42/118 and 97.9%). The 2 most common, but least specific, features are broken hairs and black dots. In conclusion, trichoscopy is a reliable new diagnostic method for hair loss caused by hair pulling. Trichoscopy should be included as a standard procedure in the differential diagnosis of trichotillomania in clinical practice.
View
View
Latent class analysis of emotions experienced during compulsive hair-pulling episodes
Article
  • Jun 2023
  • J BEHAV THER EXP PSY
Background and objectives: Reasons for compulsive hair pulling are heterogeneous and not fully understood. Given that many people who experience compulsive hair pulling do not respond to treatment, identifying subgroups can inform potential mechanisms and treatment design. Methods: We sought to identify empirical subgroups among participants in an online treatment program for trichotillomania (N = 1728). A latent class analysis was used to identify patterns of emotions associated with compulsive hair-pulling episodes. Results: Six classes of participants were found which reflected three predominant themes. One theme reflected expected patterns, where emotional changes were seen following pulling. Two other themes were more surprising, where one reflected high overall emotional activation that did not show consistent change in response to pulling, and another showed low emotional activation overall. These results suggest that there are multiple types of hair-pulling and a sizeable group of people may benefit from treatment adjustments. Limitations: Participants did not receive semi-structured diagnostic assessment. A majority of participants were Caucasian, and future research would benefit from increased participant diversity. Emotions associated with compulsive hair-pulling were measured across an entire treatment program, but the relationship between specific intervention components and change in specific emotions was not systematically collected. Conclusions: While previous research has addressed overall phenomenology and comorbidity, the present study is the first to identify empirical subgroups of people who experience compulsive hair-pulling at the level of individual pulling episodes. Identified participant classes had distinguishing features that can aid in personalizing treatment to individual symptom presentations.
View
Acquired causes of eyebrow and eyelash loss: A review and approach to diagnosis and treatment
Article
  • Nov 2022
  • AUSTRALAS J DERMATOL
Eyebrows and eyelashes serve important anatomical and social functions, and hair loss at these sites can impact patients significantly. Acquired eyebrow and eyelash loss (madarosis) may be due to a variety of underlying local or systemic disease processes; in other cases it may be idiopathic. There is a dearth of literature relating to eyebrow and eyelash loss, and there is limited guidance to help clinicians treat these clinical presentations in comparison with scalp alopecia. Here, we discuss the acquired causes of eyebrow and eyelash alopecia, our clinical approach to diagnosis and review treatment options for clinicians.
View
Trichoscopy beyond scalp. A narrative review
Article
  • May 2022
  • INT J DERMATOL
Dermoscopy is becoming an indispensable tool in everyday practice, with an expanding range of applications. Trichoscopy is effective not only in establishing the diagnosis of scalp disorders but also in the follow‐up of treatment. The MEDLINE database was searched using the terms “dermoscopy” and “trichoscopy” in combination with each of the following: “axilla,” “pubic area,” “beard,” “eyebrows,” “eyelashes,” and “body hairs.” We included case reports, case series, and review articles mentioning the previous terms. By providing an updated review from the literature, we aimed to emphasize the potential uses of trichoscopy in detecting diseases in hairy locations other than the scalp. Various inflammatory conditions, infections, and infestations are discussed.
View
Trichoscopy features of trichotillomania
Article
  • Feb 2019
Trichotillomania is a form of traction alopecia resulting from repetitive and compulsive hair pulling and plucking. Trichotillomania and patchy alopecia areata may have similar clinical and dermoscopic features in some cases. On trichoscopic examination, the presence of black dots, coiled or hook hair, shafts of varying lengths with fraying or split ends (trichoptilosis), and an absence of exclamation mark hairs and yellow dots are suggestive of trichotillomania.
View
Eyebrow Loss: Clinical Review
Article
  • Feb 2007
Loss of eyebrow hair may come to the attention of the dermatologist as a presenting complaint or as an unexpected finding on routine physical examination. Because eyebrows serve important cosmetic and social roles, their loss can be quite distressing to patients. While eyebrow loss may be an isolated finding of no medical consequence, it may also be an initial manifestation of a systemic condition. Loss of eyebrows has numerous causes including primary dermatoses, endocrinopathies, autoimmune conditions, infections, neoplasms, trauma, exogenous agents, and genetic diseases. We present a systemic review of eyebrow loss, including an algorithm that can be used to direct the work-up of patients presenting with this condition.
View