title: The combined utilization of clinical and histological findings in the diagnosis of trichotillomania.
abstract: BACKGROUND
  Trichotillomania (TM) is a chronic disorder in which patients traumatically remove their own hair in a bizarre pattern. TM histopathological findings are not well defined.
  
  
  METHODS
  Twenty-eight scalp biopsies of TM were reviewed. Multiple vertical sections and special stains were used to evaluate the specimens. Twenty-six patients (24 female, 2 male) were in the cohort, 2 patients had 2 sets of biopsies.
  
  
  RESULTS
  Age range was 13-78 years (mean 41 years), most of them presented with chronic TM. Specific histological findings included trichomalacia (57%) and pigmented casts (46%). Non-specific histological findings included: follicular plugging (96%), decreased number of follicles (96%), reversed anagen:telogen ratio (86%), decreased number of sebaceous glands (68%), melanoderma (68%), increased number of fibrous tracts (64%) and vellus hairs (57%), superficial dermal inflammation (57%), evidence of hemorrhage (18%) and presence of hair granulomas (18%).
  
  
  CONCLUSIONS
  Even though TM is often a disease of the young people, middle aged and elderly patients with TM have more often a biopsy to confirm the diagnosis. This paper suggests diagnostic criteria for TM. Specific histological findings and clinical suspicion of TM were considered major criteria, while the non-specific histological findings were considered minor diagnostic criteria for TM.
authors.affiliation: Department of Dermatology, The Cleveland Clinic Foundation, Ohio, USA.
authors.forename: Wilma
authors.initials: W
authors.lastname: Bergfeld
authors.forename: Fabiane
authors.initials: F
authors.lastname: Mulinari-Brenner
authors.forename: Karen
authors.initials: K
authors.lastname: McCarron
authors.forename: Colleen
authors.initials: C
authors.lastname: Embi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D018859:Hair Follicle / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014256:Trichotillomania / Q000175:diagnosis*