Trichotillomania

th history of progressive hair loss involving the frontal scalp and vertex.She had r loss without clinical improvement.Physical examination revealed irregular ble lengths.No erythema, scaling, follicular hyperkeratosis, pustules, or atrophy ular openings, numerous broken hair shafts of different lengths, scattered black ellow dots, or loss of follicular ostia.These findings suggested mechanical hair aled recurrent hair pulling with the fingers during episodes of emotional stress, he patient was treated with oral N-acetylcysteine and topical 5% minoxidil once ete cessation of hair-pulling behavior, with marked improvement in hair density Medicina Clínica Práctica 9 (2026) 100556