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Follow‐up of tinea capitis with trichoscopy: a prospective clinical study

examination excluded bacterial and fungal blepharitis as well as the presence of demodicosis. The consultant psychiatrist made a provisional diagnosis of personality disorder. The patient denied auto-manipulation. During hospitalization, recommended protective facial dressings resulted in visible clinical improvement. Videodermoscopy presentation – with hairs broken at different levels, flame hairs and black dots – was in line with other clinical findings and supported the diagnosis of eyelash trichotillomania (Fig 1a–c). Further psychiatric diagnostics and dermatological treatment were proposed, but the patient did not agree with our diagnosis and declared the intention of consulting other dermatologists. Trichotillomania (TTM), classified as an impulse control disorder, refers to repeated pulling out of body hair resulting in significant hair loss. It affects 0.6–3.6% of population, more commonly women. The most frequent affected site is the central region of the scalp. Isolated TTM of the eyelashes has rarely been reported. Before establishing the diagnosis of TTM, other causes of eyelash loss should be excluded. The list of differential diagnoses is long and includes associated dermatologic disorders (including hair diseases), blepharitis, endocrine/metabolic diseases, autoimmune disorders, infections, exposure to drugs/toxins, nutritional deficiency, congenital conditions. Even 70% of people affected by TTM may suffer from another body-focused repetitive behaviour, most commonly skin picking and nail biting. Careful examination of the whole skin as well as its appendages may be a clue to diagnosis. Regardless of that, patients often deny auto-manipulation. The clinical improvement observed after recommendation of protective dressings supports the diagnosis of self-inflicted skin lesions. When considering other causes of eyelash loss in such patients, videodermoscopy may be a simple, valuable diagnostic tool. The authors have found only a few reports discussing the utility of dermoscopy in the diagnosis of eyelash loss. The presence of black dots and eyelashes broken at different levels may be observed in TTM and alopecia areata. Nevertheless, the lack of coexistent exclamation mark hairs and the presence of flame hairs favour the diagnosis of eyelash TTM.To sum up, videodermoscopy may assist in diagnostics of TTM, especially in cases with denial of the illness. Funding sources that supported the work: None.