However, in this case, the regrowth of hair after injection does not mean the diagnosis was alopecia areata. There is nothing wrong with speaking to the dermatologist about use of topical steroids or another steroid injection as there can be quite a bit of inflammation that also occurs in trichtotillomania. Ongoing surveillance is appropriate for anyone with a past diagnosis of alopecia areata. One certainly needs to be humble that alopecia can always resurface in anyone who previously had the diagnosis. Your dermatologist can guide you further. In an older child and teen or adult, it’s more likely that trichotillomania alone or alopecia areata alone is the sole diagnosis in a case like this. It’s more likely to occur together in children younger than 5. It’s possible for both alopecia areata and trichotillomania to BOTH be present. Here we have features of trichotillomania as the main features. One can have exclamation mark hairs in alopecia areata and trichotillomania and this finding alone is not enough. I know there may be a thought these are exclamation mark hairs but in my opinion they are not classic exclamation mark hairs but rather broken hairs and pseudo exclamation mark hairs. A biopsy could ultimately prove whether there is any amount of alopecia areata in the front - but I don’t think this is necessary here. I can’t completely rule out “some” alopecia areata in the frontal scalp being present but it would not be the most likely scenario.
In summary, the area at the back of the scalp back in 2018 is typical of alopecia areata and the area at the front of the scalp in 2020 is typical of trichotillomania. Thanks for the submission to our Question of the Week Program. First, the appearance is quite typical of alopecia areata and the location is too, Second, the robust response to steroid injections is very much in keeping with alopecia areata as trichotillomania would not grow back quite so fast.īut let’s take a closer look at this region at the back of the scalp: The story is quite typical for your daughter having alopecia areata in 2018 at the back of the scalp. I just don’t feel that’s all that likely - at least as a major feature of the loss in this area. I don’t see any good evidence for alopecia areata in the frontal region but it can’t be completely excluded. However, I do feel that what we are seeing here is alopecia areata in the back fo the scalp (two years ago) and trichotillomania in the frontal region at the present time. This is a terrific one - and a challenging one too. and now that she has admitted to pulling, maybe there’s light at the end of the tunnel. we have been so desperate these past two years doing anything and trying anything we could to make this stop. I do see hair that looks like it could be so my question is can exclamation hair be present in someone suffering from Trichotillomania? Or is it only specific to alopecia? I appreciate any words of advice u can give.
so now I’m questioning the validity of the exclamation hair statement. this past week I had a heart to heart with my daughter and she admitted that she had in fact been pulling her hair out. then with everything happening with COVID-19 we weren’t able to see see the specialist she recommended due to being on lockdown. I took her to a dermatologist who was well versed on alopecia and she looked at her scalp thru a magnifying glass and said that she had alopecia and it was definitely AA. I questioned her numerous times about wether or not she was pulling the hair, but she always denied it.
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