Broken Hairs and Repeated Pulling: When a Hair-Growth Product Is the Wrong First Step

The short answer: solve the pulling before visiting the product aisle

When an irregular, thinning patch of scalp hair with short, broken strands keeps coming back, and especially if you notice yourself twisting, tugging or plucking hairs while working, reading or coping with stress, the instinct for many people is to shop for a fix. Topical minoxidil, biotin gummies, scalp oils and peptide serums are all marketed to people with thinning hair. But when the loss comes from hair being pulled out again and again, a hair-growth product is aimed at the wrong problem first.

That pattern can fit trichotillomania (hair-pulling disorder), which the DSM-5 places in its obsessive-compulsive and related disorders chapter. Mayo Clinic describes it as a mental health condition rather than "just a bad habit," and one that is not likely to get better without treatment. Only a clinician can confirm the diagnosis. This guide is meant to help you recognize the pattern and know what to ask, not to diagnose yourself.

The regrowth question has a conditional answer. According to the American Academy of Dermatology (AAD), regrowth after pulling is possible "if you haven't destroyed the hair follicles," and "for your hair to regrow, you have to stop pulling it." No topical, vitamin or shampoo addresses the urge or the automatic habit that drives pulling, and no medication is approved by the U.S. Food and Drug Administration (FDA) specifically for trichotillomania, as both a 2020 meta-analysis and a 2019 dermatology review note.

Short, broken hairs and patchy thinning can also come from tight hairstyles (traction alopecia), alopecia areata, a fungal scalp infection (tinea capitis) or diffuse shedding after a stressor (telogen effluvium). That is why the sensible first appointment is with a board-certified dermatologist, or a primary care clinician who can refer you. Either can examine the scalp, use magnified trichoscopy and an in-office hair pull test, look for fungal infection and, occasionally, recommend a biopsy before any treatment plan is set.

What repeated pulling actually looks like: the behavior and exposure pattern

Pulling rarely leaves a neat, round patch. DermNet describes irregularly shaped patches that "may feel stubbly, with hairs of varying lengths," and the NHS notes that bald patches "may have an unusual shape and affect 1 side of the head more than the other." A 2022 dermatology review by Melo and colleagues in Skin Appendage Disorders describes a bizarre-shaped, irregular patchy pattern with angular borders, and explains that the rough feel comes from hair shafts snapping at different points or being pulled several times. The patches are usually not fully bald: truncated and broken hairs remain scattered across them, according to a 2024 review by Onyemachi and colleagues.

Focused versus automatic pulling

Clinical sources describe two pulling styles, and DermNet notes that many people show both. Knowing which style you recognize in yourself is useful information to bring to a clinician.

Focused pulling happens with awareness. The NHS describes an intense urge and growing tension until the hair is pulled, followed by a sense of relief; Mayo Clinic adds that relief can come with pleasure or gratification. Melo and colleagues note that focused pulling often responds to negative emotional states such as stress, sadness, anger or anxiety, and that focused pullers tend to seek out hairs that feel different from the rest, such as kinky, white or odd-textured hairs. DermNet similarly notes that some people extract hairs they perceive as different in length or texture.

Automatic pulling happens largely outside awareness, during other activities such as watching television, reading, studying or talking on the phone, according to DermNet and Mayo Clinic. People may only realize afterward, when they see loose hairs or a thinner area. Melo and colleagues report that younger children more often pull automatically and may not recall pulling at all, while most adults describe focused pulling in response to stress. This is one reason "just stop" advice fails: much of the behavior starts before the person is aware of it, which is why awareness-building sits at the center of behavioral treatment.

Age of onset, sites of pulling, and the concealment burden

The NHS and Mayo Clinic both describe onset usually between the ages of 10 and 13. DermNet reports that boys and girls are affected equally in childhood but that the condition is seen more often in females with increasing age, while noting it is unclear whether that partly reflects who seeks treatment. Prevalence estimates vary by source: França and colleagues (2019) and Melo and colleagues cite 0.5% to 2% of the general population, while DermNet gives a figure of up to 4%. Several sources note that true prevalence may be higher because people feel ashamed and hide the condition, so no single number should be treated as precise.

Most people pull from the scalp, but the NHS lists eyebrows, eyelashes, the genital area and beard or moustache as other sites, and DermNet adds the trunk, arms and legs. Sites can change over time. DermNet notes that children tend to pull from easy-to-reach areas on the side of their dominant hand, usually the frontotemporal areas and the top of the head, while Melo and colleagues report that the frontoparietal region is more often affected. Pulling eyelashes can also lead to eyelid inflammation (blepharitis), one of the complications DermNet lists.

The emotional burden is real. The NHS notes that trichotillomania can cause shame and low self-esteem and that people may try to keep it to themselves. In the studies reviewed by Onyemachi and colleagues, people with trichotillomania reported significantly lower quality of life than controls, at levels similar to people with anxiety disorders, and they may feel embarrassed or ashamed to seek help. Melo and colleagues note that patients often deny the habit at first. That concealment helps explain why many people arrive at a clinic asking only about thinning hair.

Pulling versus tension: separating trichotillomania from traction alopecia

Melo and colleagues list traction alopecia among the conditions clinicians must separate from trichotillomania, and the overlap is easy to see: both can leave broken hairs. The difference lies in what is pulling on the hair, where the loss shows up and what fixes it.

Traction alopecia: styling tension and the hairline

Traction alopecia comes from hairstyles or coverings that pull on the hair for long periods. The AAD lists cornrows, locs, tightly braided hair, tightly pulled buns, ponytails and up-dos, hair extensions or weaves (especially on relaxed hair) and rollers worn to bed most of the time. Constant rubbing from a hat, head scarf or other covering can contribute, especially when hair is pulled back tightly underneath. The AAD notes that the condition is especially common among girls and women of African descent, partly because of follicle shape, and that ballet dancers, military personnel and anyone required to pull their hair back for work are also at higher risk.

According to the AAD, the hairline is one of the first places traction alopecia shows. Early signs include broken hairs around the forehead, a receding hairline and patches of loss where hair is pulled tightly. Pain from tightly pulled hair, stinging, crusts on the scalp and tenting (sections of scalp pulled up like a tent) are warning signs to change the hairstyle right away.

Timing matters. The AAD warns that traction alopecia can become permanent the longer it goes untreated, and that once it advances to shiny, bald skin, the hair cannot grow back. A dermatologist will usually recommend looser, lower-tension styles and, if changing styling habits is not enough, may prescribe medicine such as corticosteroids, antibiotics or minoxidil. Staging and treatment detail are covered in our separate guide to traction alopecia and whether edges grow back.

A note on fairness and skin of color: because traction alopecia is common with textured hair and protective styles, thinning at the hairline in someone who wears braids or locs should never be assumed to be self-inflicted. The reverse is also true: someone who wears tight styles can also pull. Both exposures can coexist, which is exactly why a professional examination matters more than any checklist.

Trichotillomania: urge-driven pulling that is not tied to a hairstyle

Trichotillomania does not depend on how hair is styled. A person with loose, short or natural hair can pull, and so can a person with tight braids. The injury comes from repeated extraction or breakage of individual hairs rather than steady tension on a whole section of scalp.

The location clues also differ. Instead of a hairline-first pattern, pulling often leaves patches that favor one side of the head (NHS), the frontotemporal areas and top of the head in children (DermNet), or the frontoparietal region (Melo and colleagues), and it may involve eyebrows and eyelashes. Sensation is another contrast: DermNet notes that pulling may be pleasurable and is not usually described as painful, whereas the AAD treats pain and stinging from a hairstyle as warning signs of traction.

The table below summarizes how clinicians frame the two patterns. It is a guide for the conversation with a clinician, not a self-diagnosis tool.

The other look-alikes a dermatologist rules out

Melo and colleagues name four conditions in the differential diagnosis for trichotillomania: alopecia areata, tinea capitis, traction alopecia and telogen effluvium. DermNet stresses that excluding other causes, especially alopecia areata, is an important part of the assessment. A dermatologist works through these systematically with history, examination and in-office tools rather than a glance in the mirror.

Trichoscopy signatures: hook hairs, flame hairs, and the V-sign

Trichoscopy is a magnified, dermoscopic examination of the scalp and hair. According to Melo and colleagues, it reveals abnormalities caused by the stretching and fracture of hair shafts. Common findings include black dots, broken hairs of different lengths and yellow dots, and several more specific variants of broken hair have been described:

• Hook or question-mark hairs: partially coiled hairs that form when the remaining hair contracts after the distal shaft has been pulled. Melo and colleagues describe them as a highly specific trichoscopic finding for trichotillomania.

• Flame hairs: semitransparent, wavy, cone-shaped hair residues that resemble a flame.

• The V-sign: two or more hairs emerging from one follicular unit and broken at the same length.

• Split or frayed ends (trichoptilosis), coiled hairs and tulip hairs: short hairs with longitudinally split ends, curled fragments or tulip-leaf-like dark tips, all listed by Melo and colleagues; DermNet also lists split or frayed ends.

• Hair powder and short vellus hairs: a sprinkled residue of damaged hair, plus fine short hairs, both included in DermNet's list of dermoscopy findings alongside reduced density and broken hairs of uneven length.

Trichoscopy also helps when the picture is subtle. Melo and colleagues describe pediatric cases without visible patches, sometimes called trichotillomania incognito, in which children had only focal low hair density and a negative pull test; trichoscopy was essential for recognizing them early. The same review notes that trichoscopy can be used to show parents the signs of plucking, which can make a hard conversation more concrete.

Clinical differential: alopecia areata, tinea capitis, and telogen effluvium

Alopecia areata is the look-alike DermNet singles out. Melo and colleagues note that it can be difficult to distinguish from trichotillomania on dermoscopy alone, and that a negative hair pull test and the absence of light-colored (hypopigmented) regrowing vellus hairs favor trichotillomania. The pull test here is an in-office assessment interpreted by a clinician, not a home test with a verdict. Readers weighing autoimmune patchy loss can see our review of alopecia areata treatment and regrowth.

Tinea capitis is a fungal scalp infection. The AAD describes scaly and sometimes inflamed areas, small black dots that are actually stubs of hair, and sometimes a bald spot; treatment can clear the infection, after which hair tends to grow. Because black dots can also appear in trichotillomania, clinicians look for other clues: DermNet lists a Wood light examination to rule out fungal infection, and the NHS notes that a GP may examine the area to check that nothing else, such as a skin infection, is causing the loss.

Telogen effluvium produces diffuse shedding rather than broken patches. The AAD describes noticing many more hairs in a brush or on a pillow a few months after giving birth, recovering from an illness or having an operation, or after a stressful life event such as a divorce or the death of a loved one. When the stress passes, the shedding usually stops, and the AAD says most people see their hair regain normal fullness within 6 to 9 months. For more, see our guide to telogen effluvium causes and recovery.

When a biopsy is used

Most of the time, history, examination and trichoscopy guide the diagnosis. Onyemachi and colleagues note that in uncertain cases a scalp biopsy is essential for a definitive diagnosis, and Melo and colleagues add that biopsy can be necessary when a patient or parents find it difficult to accept that the hair loss is self-inflicted.

On biopsy, Melo and colleagues describe a noninflammatory, nonscarring pattern with a normal number of hair follicles, more follicles in the catagen or telogen phases, bleeding in and around follicles, melanin pigment casts and malformed hair shafts (trichomalacia). DermNet lists similar findings: catagen hairs, fractured shafts, a relatively non-inflammatory dermis and follicles plugged with keratin and melanin casts.

The table below brings the look-alikes together. It reflects what clinicians check, and it is intended to help you understand the visit rather than to sort yourself into a category.

Will the hair grow back? The honest regrow-versus-permanent boundary

This is the question most people search first, and it is where the information gets least reliable. Some clinic and commercial pages offer confident week-by-week regrowth schedules. None of the authoritative sources reviewed for this article, including the AAD, DermNet, Mayo Clinic and the peer-reviewed reviews, gives a regrowth timeline after pulling stops, so this guide does not offer one either.

The two conditions for regrowth

What the sources do support is a conditional answer built on two requirements:

• The pulling has to stop. The AAD puts it plainly: "For your hair to regrow, you have to stop pulling it." Hairs that are removed again as soon as they reappear cannot rebuild density.

• The follicles have to survive. The AAD's answer begins with a condition: "If you haven't destroyed the hair follicles, yes." DermNet warns that repeated removal of hair damages the follicles and may lead to irreversible scarring, and Mayo Clinic notes that constant pulling can permanently affect hair growth.

Those warnings sit alongside reassuring evidence. Melo and colleagues describe trichotillomania as typically nonscarring, with normal follicle numbers on biopsy, and Onyemachi and colleagues write that once pulling is halted, the expectation is for hair to regrow gradually. Put together, for many people the loss is reversible, but the risk of permanent damage grows with repeated, long-term pulling in the same area. The AAD's description of scarring hair loss explains why that boundary matters: once a follicle is destroyed, it cannot grow a hair.

Who can tell which side of the boundary you are on

A mirror cannot reliably separate short broken hairs, early regrowth and scarred skin. A dermatologist can examine the area with trichoscopy and, when needed, a biopsy; findings such as normal follicle numbers without significant inflammation support a nonscarring process (Melo and colleagues; DermNet). The AAD also notes that catching scarring hair loss early can prevent further loss. That is the practical reason not to spend months on products first: the time spent waiting is time in which pulling, and any damage it causes, can continue.

What actually helps you stop: the evidence ladder for treatment

Because regrowth depends on stopping, treatment focuses on the behavior. Mayo Clinic is explicit that trichotillomania is a mental health condition, not just a bad habit, so willpower framing is both inaccurate and unhelpful. Melo and colleagues urge clinicians to take a nonjudgmental, empathic approach and advise that, for children, negative feedback and punishment for hair pulling will not produce positive results.

Behavioral therapy with habit-reversal training: the best-supported option

The strongest numbers come from a 2020 systematic review and meta-analysis by Farhat and colleagues in Depression and Anxiety, which pooled 24 randomized trials (26 comparisons, 857 participants). Behavioral therapy with habit-reversal training components (BT-HRT) showed a large benefit compared with control conditions: a standardized mean difference (SMD) of -1.22 (95% CI -1.71 to -0.73). The authors concluded that BT-HRT "has demonstrated the largest treatment effects and has the strongest evidence base" for reducing symptoms. By common convention, a standardized difference of about 0.8 or more in either direction is considered large.

Two caveats keep that number honest. The underlying trials were small and short, and long-term relapse data are limited. Melo and colleagues also note that there is no gold-standard treatment yet and that not every patient is willing or able to follow behavioral therapy. Even so, they describe cognitive behavioral therapy (CBT) as currently the most empirically validated option and the first-line treatment, especially in children, and the NHS says trichotillomania is commonly treated with habit reversal training, a type of CBT.

According to the NHS, habit reversal training usually involves the components below. They are listed to explain what therapy involves; a trained clinician adapts them to the person, so this is not a self-treatment protocol.

• Keeping a diary of hair pulling, which builds awareness of when, where and how pulling happens. That matters most for automatic pulling.

• Working out triggers and learning how to avoid them. Melo and colleagues describe a related technique, stimulus control, that changes the environment to make pulling less likely.

• Replacing pulling with another action that keeps the hands busy, often called a competing response. Melo and colleagues describe this as the core of habit reversal: build awareness, then substitute a harmless activity when the urge arrives.

• Support from loved ones. Melo and colleagues call social support a significant pillar of successful habit reversal training.

Medication: no FDA approval and an insufficient-evidence verdict

People often ask whether a prescription can switch off the urge. The current evidence calls for caution:

• FDA status: no medication is FDA-approved for trichotillomania (Farhat and colleagues; França and colleagues), and Onyemachi and colleagues note that no drug is specifically approved for it.

• The 2021 Cochrane review: reviewing randomized drug trials, Hoffman and colleagues found "insufficient evidence from meta-analysis to confirm or refute the efficacy of any agent or class of medication" in adults, children or adolescents. The 10 adult trials included 286 participants, an average of 29 per trial, and studies lasted 5 to 13 weeks.

Within that cautious frame, a few drugs have shown preliminary signals in single trials. Cochrane describes possible benefits for N-acetylcysteine, clomipramine and olanzapine in adults based on four small trials. Each is a decision for a prescriber who knows your full history; do not start, stop or change any medication on the basis of this summary.

• N-acetylcysteine (NAC): Farhat and colleagues found an SMD of -0.75 versus placebo in adult trials, but Cochrane's single pediatric trial showed little to no difference in response (25% versus 21.1% with placebo). The reviews disagree on its role: Melo and colleagues call NAC a good first-line option because of its low side-effect risk, while Onyemachi and colleagues describe mixed results. This article gives more weight to the Cochrane and Farhat syntheses, which show that the NAC evidence still rests on small trials.

• Clomipramine: a tricyclic antidepressant with an SMD of -0.71 versus placebo (Farhat and colleagues). Melo and colleagues note that its adverse effects are relatively frequent and include dry mouth, constipation, drowsiness and sedation.

• Olanzapine: an antipsychotic with an SMD of -0.94 in a single trial (Farhat and colleagues). Melo and colleagues caution that metabolic dysfunction and movement-related (extrapyramidal) side effects must be weighed against any benefit, and Cochrane notes that antipsychotics were associated with several adverse effects.

• SSRIs: Melo and colleagues note that selective serotonin reuptake inhibitors are often chosen but the evidence of benefit is weak, with fluoxetine-versus-placebo studies showing no significant differences; they may still make sense when depression or anxiety co-occur. Onyemachi and colleagues describe their efficacy as limited, and the NHS states that antidepressants are not usually prescribed to treat trichotillomania.

Navigating care: United States and United Kingdom pathways

In the United States, Mayo Clinic describes starting with a primary care clinician or a dermatologist, with referral to a mental health professional experienced in treating trichotillomania. Onyemachi and colleagues recommend that dermatologists refer early for psychiatric or behavioral evaluation when trichotillomania is suspected, particularly when depression or anxiety are also present, so that the scalp and the behavior are treated together.

In the United Kingdom (NHS pathway), the NHS advises seeing a GP if you are pulling your hair out or notice that your child is. The GP may examine the affected areas to check that nothing else, such as a skin infection, is causing the loss, and may refer you for CBT; for people under 18, this may be offered through local children and young people's mental health services. Access, waiting times and coverage differ between systems, so the UK route should not be read as a description of US care.

The table below summarizes the evidence behind each option discussed above.

Where hair-growth products fit (and where they do not)

None of this means hair-growth products are useless. It means they answer a different question, and for this pattern they belong later in the sequence, if at all.

Why products are the wrong first step during active pulling

The AAD's general principle for hair loss applies directly: the key to effective treatment is finding the cause, and "without an accurate diagnosis, treatment is often ineffective." For a pulling pattern, there are three practical problems with starting at the product shelf:

• Products do not address the behavior. Minoxidil and biotin are aimed at hair growth; neither targets the urge to pull or the automatic hand-to-hair habit. As long as hairs keep being removed, the AAD's condition for regrowth, stopping the pulling, is not being met. Our separate review covers the evidence on biotin and the FDA's warning about it.

• The diagnosis may be something else. The same broken-hair look can come from a fungal infection that needs treatment, from traction that needs a styling change, or from alopecia areata, as described above. A product chosen without a diagnosis may simply delay the right care.

• Delay is the real cost. DermNet warns that repeated removal of hair damages follicles and may lead to irreversible scarring. Months spent testing products while pulling continues are months in which that risk keeps building and effective behavioral care has not started.

Where adjuncts may fit later, with a clinician

Once a diagnosis is confirmed and the behavior is being treated, a clinician may discuss whether anything else could support regrowth. The evidence for doing so in trichotillomania specifically is thin, so these are conversations to have with a clinician, not steps to take alone:

• Minoxidil has a dermatologist-directed role for some types of hair loss; the AAD, for example, lists it among medicines a dermatologist may prescribe for traction alopecia when style changes are not enough. For pulling-related loss, any such adjunct belongs after diagnosis and alongside behavioral treatment. Our article on oral minoxidil as an off-label hair-loss drug explains why even the oral form is a prescription decision.

• Microneedling has only case-level evidence here. Onyemachi and colleagues describe a three-patient case series in which microneedling combined with topical minoxidil was used both as a regrowth aid and as a less damaging sensory substitute for pulling; the authors note it did not eliminate the compulsion and call for controlled trials. That is not a recommendation. Our review of microneedling for hair growth covers the broader evidence.

• Hair restoration procedures are something the AAD mentions for serious traction cases. With pulling, transplanted hairs could be pulled too, so any discussion of restoration logically belongs only after pulling has been under sustained control and with a hair-restoration specialist.

• Scalp massage and pattern-loss treatments address different questions. See our evidence reviews of scalp massage for hair growth and medical treatment for androgenetic alopecia if those are what you are weighing.

Getting help without shame: pathways, first appointments, and red flags

Shame keeps many people from asking for help, and the sources are clear that concealment is common rather than unusual. The NHS notes that opening up to people you trust may help, that hiding the condition can sometimes make anxiety worse, and that many people who have learned to manage trichotillomania say talking about it led to less pulling.

The dermatology-first reality and preparing for your visit

Onyemachi and colleagues write that "the majority of individuals suffering from TTM initially may present to dermatologists because of their hair loss," and that some are reluctant to disclose pulling as the cause. They recommend that dermatologists respond empathetically and bring in mental health or behavioral support early, and Melo and colleagues call for a nonjudgmental, empathic and inviting attitude. If you are not ready to say everything at the first visit, that is common; the points below can make the appointment more useful when you are ready.

• Say what you notice, including uncertainty. If you pull, twist or tug at hair, or suspect you do it without noticing, telling the clinician helps them focus the examination and the referral.

• Bring a short history. When and where pulling tends to happen, which areas are affected, any tight styles or head coverings you wear, and any recent childbirth, illness, surgery or major stress all help separate pulling from traction and telogen effluvium.

• Mention concealers and products. Tell the clinic about powders, fibers, dyes or growth products you use, and ask whether to skip any of them before the examination.

• Ask about a referral. Mayo Clinic describes referral to a mental health professional experienced in trichotillomania; you can ask directly whether therapy with habit-reversal components is available to you.

• For parents: DermNet notes that in younger children trichotillomania tends to be benign and self-limiting and is usually managed conservatively, while Melo and colleagues advise that punishment and negative feedback do not help. A clinician can advise on what fits your child's age.

Critical red flag: trichophagia and the risk of trichobezoars

Swallowing pulled hair is more common than many people assume: Melo and colleagues report that over 20% of patients may also have trichophagia, and that the resulting hairballs can cause significant gastrointestinal complications and may need surgery. In a rarer presentation they call Rapunzel syndrome, the tail of the hairball extends into the intestines and can cause obstruction. DermNet describes trichobezoar as a rare but potentially life-threatening complication, and Mayo Clinic warns that a hairball can cause intestinal blockage and even death.

Seek prompt medical care, without waiting for a routine dermatology or therapy appointment, if pulling comes with any of the following:

• Chewing or swallowing pulled hair, especially alongside stomach symptoms

• Abdominal pain, nausea, vomiting or constipation, the presenting symptoms DermNet lists for trichobezoar

• Unexplained weight loss or vomiting, which Mayo Clinic associates with a hairball

• Severe distress, hopelessness or thoughts of harming yourself; contact a clinician, a crisis line or emergency services right away

Trichotillomania is common, recognized and treatable. Moving the first step away from the product shelf and toward a professional diagnosis and evidence-backed behavioral therapy gives you the best chance to protect your follicles and get the pulling under control.

Sources

• American Academy of Dermatology (AAD). Hair loss: Who gets and causes. Consumer overview of hair-loss causes, including the conditional regrowth answer for hair pulling, scalp infection, telogen effluvium and scarring alopecia.

• American Academy of Dermatology (AAD). Hairstyles that pull can lead to hair loss. Traction alopecia exposures, early and warning signs, permanence and dermatologist treatment options.

• Hoffman J, Williams T, Rothbart R, et al. Drug treatments for chronic hair-pulling (trichotillomania). Cochrane Database of Systematic Reviews, CD007662, 2021.

• DermNet. Trichotillomania. Clinical features, diagnosis, complications including trichobezoar, and treatment overview.

• Farhat LC, Olfson E, Nasir M, et al. Pharmacological and behavioral treatment for trichotillomania: An updated systematic review with meta-analysis. Depression and Anxiety. 2020;37(8):715-727.

• França K, Kumar A, Castillo D, et al. Trichotillomania (hair pulling disorder): Clinical characteristics, psychosocial aspects, treatment approaches, and ethical considerations. Dermatologic Therapy. 2019;32(4):e12622.

• Mayo Clinic. Trichotillomania (hair-pulling disorder): Symptoms and causes. Pulling styles, symptoms, complications and where to start care.

• NHS (UK). Trichotillomania (hair pulling disorder). Symptoms, when to see a GP, habit reversal training and the UK referral pathway.

• Melo DF, Lima CDS, Piraccini BM, Tosti A. Trichotillomania: What Do We Know So Far? Skin Appendage Disorders. 2022;8(1):1-7.

• Onyemachi and colleagues. Bridging the Gap between Dermatology and Psychiatry: A Review on Quality of Life in Trichotillomania and Special Considerations in Management. Skin Appendage Disorders. 2024.