A 35-year-old woman with female pattern hair loss and a history of regular use of topical minoxidil, 2%, to the crown area for the previous 13 years was referred to us by her dermatologist for suspected factitial cutting of the hair (trichotemnomania) in the temporal regions. In fact, she had extended the application area of minoxidil to encompass the temporal and high frontal regions for years before coming to us out of fear of hair loss in these areas.
On examination, we observed androgenetic alopecia of mixed pattern with conspicuous multiple follicular blackish hair bristles the size of pinheads (0.5-1.0 mm) in the frontal region of the hairline and on both temples (Figure). Dermoscopic examination (original magnification ×10) revealed tufts of pigmented terminal hair of varying diameters emerging from each hair follicle (Figure).1 A biopsy specimen revealed a terminal hair follicle with dilated infundibulum containing hyperkeratotic material and several detached hair shafts within a keratinous sheath (Figure). The diagnosis of trichostasis spinulosa of the terminal hair type was made.
Navarini AA, Ziegler M, Kolm I, Weibel L, Huber C, Trüeb RM. Minoxidil-Induced Trichostasis Spinulosa of Terminal Hair. Arch Dermatol. 2010;146(12):1437–1438. doi:10.1001/archdermatol.2010.363
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