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Trichotillomania
Aka: Trichotillomania, Tonsure Trichotillomania
- Epidemiology
- Prevalence may be as high as 1-4%
- Most common cause of childhood Alopecia
- Younger ages affected more commonly
- Mean age of onset: 8 years (boys), 12 years (girls)
- Rarely occurs after age 40 years
- More common in females by ratio of 2.5 to 1
- Symptoms
- Patient has irresistible desire to pull out their hair
- Hair pulling episodes
- Hair twisted or twirled around finger and pulled
- Duration of minutes to hours
- Satisfaction on pulling out an entire hair with root
- May be associated with eating hair (Trichophagia)
- Sites of hair pulling
- Eyebrows and eyelashes (most common)
- Scalp (especially frontoparietal area)
- Signs: Alopecia
- Coin-sized areas of Hair Loss
- Uneven broken hairs
- Distribution
- Frontoparietal patches of Hair Loss (may advance posteriorly)
- Eyelash and eyebrow loss
- Tonsure Trichotillomania (severe)
- Completely bald except for narrow outer fringe
- Labs: Scalp biopsy
- Hair Follicle shows no inflammatory signs
- Trichomalacia pathognomonic for Trichotillomania
- Differential Diagnosis
- See Alopecia
- Alopecia Areata
- Associated Conditions
- Obsessive Compulsive Disorder (most common)
- Major Depression
- Anxiety Disorder
- Eating Disorder
- Management
- Hypnosis
- Psychotherapy with Cognitive Behavioral Therapy
- Behavior Modification (e.g. habit reversal)
- Stress Management
- Medications
- Selective Serotonin Reuptake Inhibitor (SSRI)
- Clomipramine (Anafranil) - sedating
- Olanzapine (Zyprexa)
- Acetylcysteine
- Complications
- Skin damage and secondary Skin Infections
- Scarring
- Decreased self esteem
- Social avoidance
- References
- Habif (1996) Clinical Dermatology, Mosby, p. 755
- Tasman (1997) Psychiatry, Saunders, p. 1271-8
- Koo (2001) Am Fam Physician 64(11):1873-78 [PubMed]
- Messinger (1999) Pediatr Rev 20(7):249-50 [PubMed]
- Phillips (2017) Am Fam Physician 96(6): 371-8 [PubMed]