Trichotillomania and Trichophagia: Modern Diagnostic and Therapeutic Methods

Trichotillomania is a chronic, mental disease of impulse control, characterized by repetitive, compulsive, and self-induced hair pulling. It can occur at any age but is observed more often in adolescents, with a strong predominance in females. Diagnosis of trichotillomania may be difficult, and its effective treatment challenging. The aim of this study is to critically review current literature regarding diagnostic procedures and treatment of trichotillomania, including psychotherapy, N-acetylcysteine, naltrexone, topiramate, atypical neuroleptics, and selective serotonin-reuptake inhibitors. The importance of cooperation between dermatologists and psychiatrists is emphasized to shorten the time to diagnose the disease and begin appropriate treatment. Finally, trichotillomania is also often connected with trichophagia, which may lead to formation of trichobezoars and cause a direct danger to the patient's health and even life due to the risk of intestinal obstruction and the need for surgical intervention. Based on thorough literature review, we conclude that diagnosis of trichotillomania can be challenging. Trichoscopy could help to distinguish trichotillomania from other types of hair loss. Most clinical trials using various treatment options have been conducted on small groups of patients, and the potential benefits determined using various scales. Therefore, it is difficult to compare the effectiveness of different treatment methods. There is also a lack of studies assessing treatment efficacy over longer periods of time. Thus, there is a need to perform better-designed studies in the near future to optimize current treatment modalities for trichotillomania.