Trichotillomania Incognita in an Adult Female: A Great Mimicker Worth Attention

This article discusses a case of trichotillomania incognita (TTM-i) in a 22-year-old female, which mimicked female patterned hair loss (FPHL). TTM-i, a variant of trichotillomania, typically presents as diffuse hair loss without the classic alopecic patches and has been previously described only in children. The patient exhibited diffuse hair loss corresponding to Sinclair grade 2 of FPHL, with no awareness of hair-pulling. Dermoscopic and histological examinations confirmed TTM-i, showing features like trichoptilosis and flame hairs. The case highlights the importance of trichoscopy and histopathology in diagnosing TTM-i, which can be mistaken for other hair loss conditions, potentially leading to inappropriate treatments. The study suggests TTM-i as a subset of TTM characterized by low-intensity hair-pulling, resulting in chronic hair shaft trauma but lacking acute features like hemorrhage.