There are specific histological findings that are diagnostic of trichotillomania, the chronic psychiatric disorder in which patients pull, twist, pluck and otherwise remove their own hair in a traumatic and bizarre pattern.
Patients may deny the hair removal (in some cases the twisting and pulling may be subconscious) and insist it is a disorder such as alopecia (which trichotillomania may resemble).
A review of 28 scalp biopsies from 26 patients (24 female, two male) found trichomalacia (incompletely keratinized, distorted, and pigmented hair shafts) was a major criterion for diagnosis, as was pigmented casts. The researchers looked at multiple vertical sections. Evaluation of the specimens was undertaken using special stains.
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