Trichoscopic Overlap of Trichotillomania Superseding Alopecia Areata: A Report of Two Cases

Abstract

Trichoscopy is a non invasive tool useful for diagnosis of dermatoses on hair bearing skin. Alopecia Areata (AA) is a common non scarring alopecia with varying aetiologies including autoimmune and genetic factors. Trichotillomania (TTM) is a psychocutaneous dermatosis characterised by compulsive hair plucking leading to hair loss at accessible sites. Trichoscopy can be used for diagnosing both these dermatoses at an early stage due to presence of distinct trichoscopic signs. Authors hereby intend to report two cases presenting with a trichoscopic overlap of trichotillomania superseding alopecia areata. First case was of a 27-year-old male presented with patchy hair loss for three months over scalp. On clinical examination, the case appeared to be of AA with involvement of three well-defined patches on the scalp, though trichoscopy suggested an overlap of AA with TTM. On probing patient gave a history of stressors predominantly of unemployment due to Coronavirus Disease-2019 (COVID-19) pandemic but denied the history of compulsive hair pulling, indicating that TTM must have superseded patches AA. The second case was a 20-year-old female presenting with a single patch of hair loss over mid scalp. There was atrophy in the centre and easy pluckability at borders. Trichoscopy yet again suggested an overlap of AA with TTM. The patch of AA was persistent in the patient giving rise to depression and anxiety which had probably provoked hair plucking. TTM and AA are two distinct clinical entities but can be simultaneously present in patients. Trichoscopy can be indeed helpful for diagnosis in such cases. Treatment modalities should therefore address both these conditions in such cases for better outcomes.