Trichoscopic findings of trichotillomania: new observations

Introduction
Recently, dermoscopy of the hair and scalp, also known as trichoscopy, has become an important diagnostic tool in the diagnosis of hair diseases. There are few studies describing trichoscopic findings of trichotillomania (TTM).

Aim
To evaluate and identify specific trichoscopic features of TTM.

Material and methods
The study included 20 patients diagnosed with TTM on the basis of the clinical history, physical examination and trichoscopic findings. All of the trichoscopic images of the patients were retrospectively reviewed and the findings identified were recorded. Descriptive statistical analysis was performed.

Results
The findings detected were broken hairs at different levels (100%), short vellus hairs ( 90%), black dots (85%), trichoptilosis (75%), V hair (70%), hair powder (65%), yellow dots (55%), Mace hair (45%), coiled hairs (45%), exclamation mark hair (40%), blood spots (40%), branched hair (40%), angulated hair (40%), concentric hair (35%), flame hair (30%), and tulip hair (25%).

Conclusions
Here we have documented trichoscopic findings of TTM retrospectively. Trichoptilosis, V hair and hair powder were the most frequent relatively specific findings. We tried to define novel findings that we named branched hair and concentric hair. We also detected Mace hair in 9 cases. Mace hair was previously described just in 3 cases of TTM in a case study. Angulated hairs, to the best of our knowledge, were also firstly described for TTM in the present study. Lack of a comparison group is the main limitation of the study.