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Trichotillomania in Children
Nisha Suyien Chandran1, Jeroen Novak2, Matilde Iorizzo3
1Division of Dermatology, University Medicine Cluster, National University Hospital, Singapore, Singapore.
Insights
Trichotillomania in children is often missed. This study analyzed 33 pediatric cases, finding it more common in girls and often presenting with scalp hair pulling, with parents frequently unaware of the behavior.
Area of Science:
- Pediatric dermatology
- Child psychology
- Behavioral science
Background:
- Trichotillomania (hair-pulling disorder) is frequently underdiagnosed in children.
- Limited data exists on the specific characteristics of pediatric trichotillomania.
- Understanding childhood trichotillomania is crucial for early identification and intervention.
Purpose of the Study:
- To characterize pediatric trichotillomania by analyzing patient demographics, clinical presentation, and potential triggers.
- To enhance clinical awareness and diagnostic capabilities for this condition in children.
- To provide a foundation for future research into childhood trichotillomania.
Main Methods:
- Retrospective analysis of an electronic database from a tertiary children's hospital.
- Systematic classification of patient data using the '5 Ws and 1 H' framework (Who, What, When, Where, Why, How).
- Inclusion of data on patient demographics, clinical signs, observed triggers, and diagnostic tests.
Main Results:
- 33 patients diagnosed with trichotillomania (28 female, 5 male), with a peak age of 3-4 years.
- Scalp hair pulling was most common; nail biting co-occurred in 5 patients.
- Parents noticed hair pulling in only 51.5% of cases; hair found on bedding was a common clue. Triggers included appearance, family, school, and illness. The hair pull test was negative in all patients.
Conclusions:
- A structured questioning approach based on '5 Ws and 1 H' aids in diagnosing unexplained nonscarring hair loss in children.
- This method assists clinicians, especially those unfamiliar with trichotillomania, in gathering essential information.
- Increased clinician awareness of trichotillomania characteristics can improve diagnosis and management of this condition.
Background:
Trichotillomania is an often underdiagnosed condition. Little is known about trichotillomania in childhood. We aimed to analyze the characteristics of children with trichotillomania to increase information on this condition.
Methods:
A retrospective study of an electronic database was performed in a tertiary children's hospital. Information from patients with trichotillomania was systematically classified under the categories 'who', 'what', 'when', 'where', 'why', and 'how'.
Results:
A total of 33 patients had a diagnosis of trichotillomania (28 females, 5 males; peak age between 3 and 4 years). Scalp involvement was most common and nail biting was observed in 5 patients. Only 51.5% of patients had parents who noticed their child's hairpulling. Hair on or under the bed was the most common clue suggesting that hairpulling occurred. Triggering factors identified in 16 children included physical appearance, family-related issues, school-related issues, and concurrent illness. The noninvasive hair pull test was negative in all children. There was a high non-follow-up rate, and treatment outcomes varied.
Conclusion:
A set of 6 specific questions, based on the '5Ws and 1H' principle, facilitates the gathering of important information on children with unexplained nonscarring hair loss and helps clinicians be cognizant of possible outcomes of trichotillomania. This will be especially useful to clinicians who are not familiar with this elusive condition.
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