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A dermatological assessment may include: Hair pull test negative Wood light to rule out fungal infection Dermatoscopy and/or trichoscopy findings: Reduced hair density Broken hairs of uneven length Trichoptillosis (split/frayed ends) Hair powder Short vellus hairs Biopsy and histology findings: Catagen hairs Dystrophic hairs Relatively non-inflammatory dermis Fractured hair shafts Plugging of dilated follicles with debris (keratin and melanin casts) A psychiatric evaluation may also necessary but may be difficult in young children

The cost varies depending on the expertise of the provider and location