In a case of a 14-year-old girl with hair loss and underlying normal skin, what condition is indicated?

• A. Alopecia areata
• B. Trichotillomania
• C. Telogen effluvium
• D. Androgenetic alopecia

Answer: (B)

In the scenario presented, the patient's symptom of hair loss in conjunction with normal underlying skin strongly suggests trichotillomania. This condition is characterized by the compulsive urge to pull out one's own hair, leading to noticeable hair loss. Importantly, the skin appears normal in those areas because the underlying condition is a behavioral issue rather than a dermatological disease.

In trichotillomania, the hair puller often does so in response to stress, anxiety, or other emotional factors. The condition is classified as an impulse control disorder, distinguishing it from other forms of hair loss, which often have different underlying physiological causes or characteristics.

The other conditions would typically involve associated signs or symptoms that are not observed in this case. For instance, alopecia areata usually presents with patchy hair loss and may show signs of inflammation. Telogen effluvium often results in diffuse thinning due to a variety of factors but is usually tied to significant changes or traumas in the body and might result in some scalp changes. Androgenetic alopecia typically has a patterned appearance and is influenced by genetic factors, making it distinctly different from the scenario described.

Thus, given the details of hair loss with a normal appearance of the underlying skin