How to Cover Trichotillomania Bald Spots

If you have a trichotillomania bald spot from hair pulling, you probably already spend time each day hiding it: checking the mirror, fixing your parting, choosing a hat. You’re far from alone: hiding hair loss is one of the most common parts of trichotillomania (trich), and it takes a lot of energy.

This guide is about making covering quicker and easier. It starts with fast fixes, then covers hairstyles, hair fibres, sprays, toppers, and what to avoid. The aim isn’t perfection, just a patch that bothers you less while your hair grows back.

What are the quickest ways to cover a trichotillomania bald spot?

The quickest ways to cover a patch are to move your parting, wear a hat or scarf, or tint the skin underneath with a root spray or powder so the patch blends in. Which suits you depends on the size of the patch and where it is.

Keep a small kit where you get ready and a travel version in your bag. Knowing you can fix things in a couple of minutes takes a lot of worry out of wind and rain.

Which hairstyles help?

The best hairstyles move hair over the patch or draw the eye away from it, without pulling tightly. A hairdresser or barber can also shape a cut around thinner areas.

Ideas to try:

• Move your parting. A deep side parting or a zigzag one lays hair across a patch on top. Switching sides covers a patch beside your usual parting.
• Add volume at the roots. Mousse or volumising spray at the crown lifts hair so it covers more.
• Add texture. Loose waves or curls hide gaps better than very straight, flat hair.
• Try a fringe or curtain fringe if your patches are near your hairline.
• Wear it loose or in a low, soft style. Loose buns, low ponytails and soft half-up styles cover the back and sides without strain.
• Go shorter, if you like the idea. An even, shorter cut makes small patches blend in, and the NHS lists cutting your hair short as one thing to try to pull less.
• Use colour. The closer your hair colour is to your skin tone, the less a thin area shows.

Headbands, scarves and hats are everyday fashion, so nobody reads anything into them. For hats, the American Academy of Dermatology (AAD), the professional body for US skin and hair doctors, suggests silk or satin linings, which are gentler on hair than rougher fabrics. A satin-lined beanie is an easy one to keep by the door.

Do hair fibres work?

Yes, hair fibres can work well for thin areas, but they need some hair to cling to. Hair fibres are tiny coloured strands, often made from keratin (the protein hair is made of), that you shake over the area. A 2017 review of hair camouflage in the International Journal of Women’s Dermatology explains that they carry a small electric charge, so they stick to nearby hairs and make them look thicker. On smooth, hairless skin they have nothing to hold on to.

That makes hair building fibres a good fit for regrowth, thin areas where the scalp shows through, and the edges of a larger patch. To use them, style your hair first, dry it fully, then shake or puff the fibres over the area and pat gently. A light hairspray on top helps them stay put. They wash out with shampoo and need putting on again each day. Pick a shade close to your roots.

Root sprays and powders work in a similar way, by tinting the scalp so it doesn’t stand out against your hair. The same review notes that products like these need applying every day and can be disturbed by swimming and other water. A root touch-up spray covers quickly, while a root concealer powder is easier to control around a small patch. In a pinch, a matte eyeshadow or brow powder close to your root colour, pressed on with a small brush, does the same job.

One thing to watch: short, new hairs are often exactly the kind people with trich want to pull, and putting products on means touching the area. If your fingers start lingering, finish, wash your hands and step away from the mirror.

What about toppers?

A hair topper is a partial hairpiece that clips onto your own hair to cover the crown, the top of the head or a parting. It blends into your hair at the edges, so it suits larger patches on top that styling and sprays can’t cover.

What to know before you buy:

• Size. Choose a base a little larger than your patch.
• Most attach with small clips. Clips need some hair to grip. Place them into healthy hair around the patch, not at its edge, and move them a little each day so the same hairs don’t take the strain.
• Human hair or synthetic. Toppers come in both. They differ in how you can style them, how long they last and what they cost, so ask the seller how each one is cared for.
• Weight matters. The Saed review notes that the constant tension of hair extensions on natural hair has caused traction alopecia. A lighter topper with fewer, well-spread clips puts less strain on your own hair.

Clip-in hair toppers come in many colours and lengths. For very large or several patches, a full wig may be simpler. Our guide to wigs and hair systems for trichotillomania covers types, fit and cost.

Can covering up help you pull less?

Yes, some ways of covering a patch can also help you pull less. The NHS suggests wearing a bandana or a close-fitting hat, such as a beanie, as something to try, because it puts a barrier between your fingers and your hair. A hat or scarf at home in the evening, or a soft beanie in bed, covers the patch and blocks automatic pulling at the same time.

Wigs and toppers can work the same way for some people, though pulling can still happen at the edges or when they come off.

Covering can work against you if it means lots of checking. Looking closely at a patch in the mirror is a common lead-in to pulling. It can help to:

• get ready with a normal mirror, not a magnifying one
• do a single check once you’re ready, then put the mirror away
• style the patch last, with hands busy straight afterwards

For more ideas on the pulling itself, our guide on how to stop pulling your hair covers urges, triggers and barriers step by step.

What should I avoid when covering a bald spot?

Avoid anything that pulls on, rubs or irritates the area, because it can cause hair loss of its own. The AAD warns that tight ponytails, buns, braids, extensions and weaves can lead to traction alopecia, and that constant rubbing from a hat or head covering can too.

Keep in mind:

• Loosen up. Don’t pin or tie hair tightly across the patch to hold it in place. If a style hurts or leaves your scalp tender, it’s too tight.
• Take care with glue and tape. The Saed review reports allergic reactions of the skin to wig and hairpiece adhesives. Never put glue, tape or strong products on skin that is broken or sore from pulling.
• Change it up. Rotate styles, clip positions and hats so the same area isn’t under strain every day.
• Be cautious with permanent options. Scalp micropigmentation, a cosmetic tattoo that mimics short hairs, is permanent while your pulling and your hair may change. Speak to a dermatologist (a doctor for skin and hair) before deciding.

Gentle covering protects the hair that grows back. There’s more on timelines in our article on whether hair grows back after trichotillomania. The regrowth section of our complete guide explains what to expect over the coming months.

When should I get help?

Get help if hiding your hair loss is taking over your time or your life, or if the patches are growing. Needing to cover up isn’t a failure. Researchers describe some secrecy and hiding as almost universal in trich, and the NHS notes that keeping it to yourself can sometimes make anxiety worse.

Signs it’s worth talking to someone:

• you’re avoiding swimming, windy days, haircuts, dates or photos
• covering up is taking a lot of time or money
• you feel low, anxious or ashamed about your hair much of the time
• the patches keep spreading despite your efforts

Someone who understands hair pulling can help with both the pulling and the stress of hiding it. You can search our directory for someone near you or online.

If you’re feeling very low or hopeless, please talk to someone today.

In an emergency, call 000 or go to your nearest emergency department.

• Lifeline — 13 11 14 (www.lifeline.org.au)

Questions people ask

Sources

1. Saed, S., Ibrahim, O. & Bergfeld, W.F. (2017). Hair camouflage: A comprehensive review. International Journal of Women’s Dermatology, 3(1 Suppl), S75–S80.
2. American Academy of Dermatology. Hairstyles that pull can lead to hair loss.
3. NHS. Trichotillomania (hair pulling disorder).
4. Woods, D.W., Flessner, C.A., Franklin, M.E., Keuthen, N.J., Goodwin, R.D., Stein, D.J., Walther, M.R. et al. (2006). The Trichotillomania Impact Project (TIP): Exploring phenomenology, functional impairment, and treatment utilization. Journal of Clinical Psychiatry, 67(12), 1877–1888.
5. Slikboer, R., Castle, D.J., Nedeljkovic, M. & Rossell, S.L. (2018). Types of avoidance in hair-pulling disorder (trichotillomania): An exploratory and confirmatory analysis. Psychiatry Research, 261, 154–160.