Supplementary Material for: An Unusual Compulsive Behavior Related to Scalp Psoriasis and Hair Follicle Anxiety in Young Men

Introduction: Patients suffering from androgenetic alopecia may experience obsessive behaviors on observing their own scalp. Case Presentation: This article describes a series of three cases of young men presenting with an unusual, seemingly compulsive behavior related to mild scalp psoriasis and a family history of androgenetic alopecia. Contrary to the typical goal of psoriasis treatment, these patients exhibit an intense fixation on scalp scales containing embedded hairs. They actively avoid dislodging these scales during routine hygiene or therapeutic efforts, fearing that their removal might accelerate hair loss. The cases involve young men (aged 24, 19, and 22) with significant anxiety about hair loss, which manifests as a meticulous and repetitive manipulation of their scalps to preserve these specific scales. Conclusion: This behavior may fall within the spectrum of body-focused repetitive behaviors (BFRBs). This observation underscores the importance for dermatologists to thoroughly question patients about underlying anxieties and specific scalp manipulation behaviors, especially in young men with a familial history of alopecia, to facilitate more effective clinical management.