Sleep-isolated trichotillomania: a survey of dermatologists

To determine whether sleep-isolated trichotillomania has been recognized or suspected by dermatologists.

Eight-hundred and seven practicing dermatologists in the Midwest were identified through the American Academy of Dermatologists website database. A 10-question multiple-choice survey regarding trichotillomania was mailed to each. Responses were anonymously returned by fax.

A total of 107 (13%) of the 807 dermatologists surveyed responded. Twelve (11%) reported having seen patients with trichotillomania that occurred solely during sleep. In cases of unexplained hair loss, 21(20%) suspected hair-pulling occurred only in sleep. Seventy-six subjects (71%) said they had seen patients with unexplained hair loss; 67 (88%) of those respondents said they would ask those patients if they pull their hair. Only 16 (24%) said they would ask patients who deny hair pulling while awake if they pull their hair during sleep. Twenty (19%) said they ask patients diagnosed with trichotillomania if hair pulling also occurs in sleep.

Although sleep-isolated trichotillomania has only recently been reported, some dermatologists report having recognized this entity in their own practices. When dermatologists see patients with unexplained hair loss, only a small percentage consider trichotillomania isolated to sleep. Increased physician awareness of this disorder may allow diagnosis and treatment of many patients.