A Case of Trichotillomania Presenting as a Factitious Ulcer

A 30-year-old woman with trichotillomania presented with a nonhealing scalp ulcer after initially seeking dermatological treatment. Despite using antibiotics and ointments, her condition persisted. Upon psychiatric evaluation, she admitted to hair-pulling triggered by stress, leading to temporary relief. She exhibited moderate depressive and anxiety symptoms, scoring 17 on the Hamilton Depression Rating Scale and 14 on the Hamilton Anxiety Rating Scale. Treatment included clomipramine, N-acetylcysteine, and habit reversal training, which improved her symptoms. The case underscores the importance of a multidisciplinary approach and awareness in diagnosing and treating trichotillomania, especially when patients are unaware or uncooperative.