An adolescent aged 12 years presented with progressive bilateral eyebrow and eyelash loss. The physical examination revealed sparse hair in both regions (Fig. 1), while scalp hair was spared. The dermoscopy examination of the brows allowed visualization of the V-sign (purple), black dots, flame hairs and broken hairs. Absence of micro-exclamation points (Fig. 1B). The trichoscopy examination of the lashes revealed tulip hairs (fuchsia), flame hairs (red), puntos negros (negro) and empty hair follicles (yellow) (Fig. 1D).

Figure 1.

(A) and (B) Sparse eyebrows and corresponding dermoscopy image. (C) and (D) Sparse eyelashes and trichoscopy image in the same patient.

The patient acknowledged compulsive and uncontrollable pulling of her eyebrows and eyelashes, leading to diagnosis of trichotillomania.

Trichotillomania is an obsessive-compulsive disorder characterized by recurrent pulling of one’s hair, lashes, brows, upper lip or chin hair or body hair. The differential diagnosis includes tinea infection, alopecia areata and congenital anomalies, among other diseases.1–3

Dermoscopy is a very useful tool that can contribute key signs for the diagnosis of this condition.