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Trichotillomania: What Do We Know So Far?

Daniel Fernandes Melo1, Caren Dos Santos Lima2,3, Bianca Maria Piraccini4,5

  • 1Dermatology Department, University of State of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.

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|February 4, 2022
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Summary

Trichotillomania is a disorder where individuals pull out their hair, often presenting with patchy hair loss. Treatment requires a comprehensive, interdisciplinary approach including behavioral therapy and pharmacotherapy, with N-acetylcysteine as a promising option.

Keywords:
AlopeciaHair pullingImpulse-control disorderTrichotillomania

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Area of Science:

  • Dermatology
  • Psychiatry
  • Psychology

Background:

  • Trichotillomania is characterized by recurrent hair pulling, predominantly affecting females, often with denial and presenting as patchy alopecia.
  • Diagnostic challenges include differentiating self-inflicted hair loss from other alopecias, necessitating trichoscopy and sometimes biopsy.
  • The disorder requires a multidisciplinary approach, emphasizing physician empathy and patient/parent education.

Purpose of the Study:

  • To review the current literature on trichotillomania.
  • To discuss etiology, clinical and diagnostic features, and management strategies.
  • To highlight the importance of an interdisciplinary approach and supportive care.

Main Methods:

  • Literature review of trichotillomania.
  • Analysis of clinical, trichoscopic, and histopathological findings.
  • Evaluation of psychological and pharmacological treatment options.

Main Results:

  • Trichotillomania presents with characteristic nonscarring alopecia and hair shaft abnormalities visible on trichoscopy.
  • Behavioral therapy is effective but compliance can be an issue; pharmacotherapy, including N-acetylcysteine, offers an alternative.
  • Psychiatry-dermatology liaison and strong social/familial support are crucial for successful management, especially in pediatric cases.

Conclusions:

  • Trichotillomania management necessitates a comprehensive, interdisciplinary strategy.
  • Pharmacological options, particularly N-acetylcysteine, show promise with favorable side-effect profiles.
  • Integrated care involving medical professionals, psychological support, and family involvement is key to remission.