At a glance Alopecia areata v trichotillomania

Alopecia areata

Clinical features

  • Sudden loss of one or more patches of hair.
  • Sometimes develops after stress.
  • More common in Down’s syndrome.
  • May affect more than one member of a family.
  • In the active phase, exclamation mark hairs may be seen at the edge of the bald patch.

Management

  • There is no cure but there is hope of regrowth.
  • Counsel the patient and offer psychological support — offer a wig if the patient is concerned.
  • Treatment options include intralesional steroids for patchy loss; contact immunotherapy for more extensive loss (diphenylcyclopropenone); potent topical steroids are sometimes tried; pulsed systemic steroids and PUVA.

Trichotillomania

Clinical features

  • Self-induced hair loss due to twisting, pulling or cutting the hair.
  • More common in women.
  • Patient usually denies causing the problem.
  • Patient may display other forms of self-harm.
  • Uneven loss with diffuse or bare patches.
  • Broken or cut hairs seen in the scalp.
  • If the pulled hair is eaten it may cause intestinal obstruction. 

Management

  • Biopsy to exclude other causes, if necessary.
  • Offer support or behavioural therapy. 

Contributed by Dr Jean Watkins, a GP in Ringwood, Hampshire

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