Trichoscopy in differential diagnosis of trichotillomania: literature review and own observations

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Diagnosing of trichotillomania (TTM) is often difficult because the clinical presentation may be similar to other conditions, more often — to alopecia areata (AA). Patients themselves may deny hair autodestruction. Non-invasive optic diagnostic method — trichoscopy — may assist in making a diagnosis. Aim: to specify the range of trichoscopic signs of TTM and their value in differential diagnosis with AA according to the systematic review of the literature and descriptive analysis of the results. Methods. Systematic review was carried out by literature search in databases PubMed, EMBASE, and eLibrary. From 119 found articles, nine matched the inclusion criteria and were included in quantitative analysis. Systematic review data on the range and incidence of trichoscopic signs of TTM was compared with similar data on trichoscopic signs of AA from the literature. Results. According to analyzed literature, the most common trihoscopic sign in TTM is broken hair (90-100%) characterized by various length and changes in loose ends (trichoptilosis, twisted, tulip-shaped). Unlike alopecia areata, in trichotillomania proximal hair shaft changes (exclamation mark-like hair, tapered hair narrowed at the base), yellow dots and vellus hair are not characteristic and are seen rarely. It is useful to find rare but characteristic signs of TTM: V-shaped, tulip-shaped or flame-like hairs. Conclusion. Despite the possibility of finding similar trichoscopic signs in TTM and AA, in mechanical damage to hair specific to TTM a number of characteristic signs form, which may help us suspect this condition on time.

Keywords:

trichotillomania

alopecia areata

trichoscopy

alopecia

Authors:

Romanova Yu.Yu.

Moscow Sientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia, 119071

Michenko A.V.

Pervyĭ MGMU im. I.M. Sechenova

Lvov A.N.

Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia

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