Trichotillomania is classified by the American Psychiatric Association Diagnostics and Statistics Manual for Mental Health Disorders, Fourth Edition as an impulse-control disorder and occurs with an prevalence of 0.6-3.4% of adults. The underlying psychiatric comorbidity or functional impairment is well recognised by clinicians. Patients with trichotillomania pull their scalp hairs, resulting in damaged, distorted hair follicles, and broken hair shafts within the skin. The local irritation and inflammation resulting from reaction to the broken, impacted hair shafts and malaligned regrowing hairs can lead to pseudofolliculitis, much the same as a patient who waxes or shaves her legs gets itchy papules of pseudofolliculitis. Pseudofolliculitis becomes an organic reason for scalp itch and discomfort, and contributes further to the vicious cycle of itch and scratching in trichotillomania. This phenomenon has not been well documented. Treatment of trichotillomania would be more effective if the pseudofolliculitis component is addressed. We describe a series of patients with trichotillomania and pseudofolliculitis. Most of these patients improved after topical or oral antibiotics, and some topical steroid lotion. Hair regrowth was also visibly better, with patients reporting improvement of symptoms of itch. All these patients were not put on antidepressants nor antipsychotics. We highlight the association between trichotillomania and pseudofolliculitis. Treatment of trichotillomania is more effective if the underlying pseudofolliculitis component is addressed.