Trichotillomania

Aka: Trichotillomania, Tonsure Trichotillomania

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II. Epidemiology

  1. Prevalence may be as high as 1-4%
  2. Most common cause of childhood Alopecia
  3. Younger ages affected more commonly
    1. Mean age of onset: 8 years (boys), 12 years (girls)
    2. Rarely occurs after age 40 years
  4. More common in females by ratio of 2.5 to 1

III. Symptoms

  1. Patient has irresistible desire to pull out their hair
  2. Hair pulling episodes
    1. Hair twisted or twirled around finger and pulled
    2. Duration of minutes to hours
    3. Satisfaction on pulling out an entire hair with root
    4. May be associated with eating hair (Trichophagia)
  3. Sites of hair pulling
    1. Eyebrows and eyelashes (most common)
    2. Scalp (especially frontoparietal area)

IV. Signs: Alopecia

  1. Coin-sized areas of Hair Loss
    1. Uneven broken hairs
  2. Distribution
    1. Frontoparietal patches of Hair Loss (may advance posteriorly)
    2. Eyelash and eyebrow loss
  3. Tonsure Trichotillomania (severe)
    1. Completely bald except for narrow outer fringe

V. Labs: Scalp biopsy

  1. Hair Follicle shows no inflammatory signs
  2. Trichomalacia pathognomonic for Trichotillomania

VI. Differential Diagnosis

  1. See Alopecia
  2. Alopecia Areata

VII. Associated Conditions

  1. Obsessive Compulsive Disorder (most common)
  2. Major Depression
  3. Anxiety Disorder
  4. Eating Disorder

VIII. Management

  1. Hypnosis
  2. Psychotherapy with Cognitive Behavioral Therapy
  3. Behavior Modification (e.g. habit reversal)
  4. Stress Management
  5. Medications
    1. Selective Serotonin Reuptake Inhibitor (SSRI)
    2. Clomipramine (Anafranil) - sedating
    3. Olanzapine (Zyprexa)
    4. Acetylcysteine

IX. Complications

  1. Skin damage and secondary Skin Infections
  2. Scarring
  3. Decreased self esteem
  4. Social avoidance

X. References

  1. Habif (1996) Clinical Dermatology, Mosby, p. 755
  2. Tasman (1997) Psychiatry, Saunders, p. 1271-8
  3. Koo (2001) Am Fam Physician 64(11):1873-78 [PubMed]
  4. Messinger (1999) Pediatr Rev 20(7):249-50 [PubMed]
  5. Phillips (2017) Am Fam Physician 96(6): 371-8 [PubMed]

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Ontology: Trichotillomania (C0040953)

Definition (NCI) A disorder characterized by repetitive pulling out of one's hair resulting in noticeable hair loss; the individual experiences a rising subjective sense of tension before pulling out the hair and a sense of gratification or relief when pulling out the hair.
Definition (MSH) Compulsion to pull out one's hair.
Definition (PSY) Excessive pulling of one's own hair.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D014256
ICD10 F63.3
SnomedCT 192032006, 17155009
DSM4 312.39
English Trichotillomanias, trichotillomania, pulling out one's hair, pulling out one's hair (symptom), trichotillomania (diagnosis), TRICHOTILLOMANIA, TTM, Hair pulling, chronic, compulsive, repetitive, Trichotillomania, Trichotillomania [Disease/Finding], pull hair, hair pulling, pulling hair, hair plucking, hair pull, plucking hair, Trichologia, Hair plucking, Trichotillomania (disorder), hair-pulling, plucking, Hair Pulling
Dutch haar uittrekken, trichotillomanie, Trichollomania, Trichotillomanie
French Arrachage des cheveux, Alopécie par grattage, Manie dépilatoire, Trichomanie, Trichotillomanie
German Haarausreissen, Trichotillomanie, Haarausreißen
Italian Fragilità dei capelli, Tricotillomania
Portuguese Arrancar cabelo, Tricotilomania
Spanish Arrancamiento del pelo, arrancamiento del cabello, tricología, tricotilomanía (trastorno), tricotilomanía, Tricotilomanía
Japanese 抜毛, 抜毛癖, ﾊﾞﾂﾓｳ, ﾊﾞﾂﾓｳﾍｷ
Swedish Hårryckningsmani
Czech trichotilomanie, Trichotilománie, Vytrhávání vlasů
Finnish Karvojennyppimishäiriö
Russian TRIKHOTILLOMANIIA, TRIKHOKRIPTOMANIIA, ТРИХОКРИПТОМАНИЯ, ТРИХОТИЛЛОМАНИЯ
Korean 발모벽
Polish Trichotillomania, Nawyk wyrywania sobie włosów
Hungarian Hajtépdesés, Trichotillomania
Norwegian Trikotillomani, Hårutrivning, Hårnapping
Derived from the NIH UMLS (Unified Medical Language System)

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