Trichotillomania - Causes, Symptoms and Treatment

Trichotillomania is an impulse control disorder. Trichotillomania (trichotillosis) is alopecia resulting from repetitive hair manipulations by the patient's own hand. Trichotillomania is the most common cause of hair loss in children. The hair may be lost in round patches or diffusely across the scalp. It is characterized by the repeated urge to pull out scalp hair, eyelashes, beard hair, nose hair, pubic hair, eyebrows or other body hair. Trichotillomania is a primary psychiatric disorder, but, from a dermatological standpoint, it is one of traumatic alopecia. The causative trauma to the hairs occurs as a result of the patient's repetitive hair-pulling behavior. The compulsion is characterized by increasing tension that is finally relieved when the hair is pulled. Patients may describe an unrelenting pain or itch that builds until they pluck the hair. In adult groups, most patients are women. In adolescents, girls are affected more often than boys. In children, the sex distribution is uncertain, but it appears that the younger the sample, the more equal the sex distribution.Trichotillomania can cause a child to experience distress and may result in impaired social or family functioning. Many times, children feel ashamed and embarrassed by the hair loss caused by pulling. Additionally, trichotillomania may result in impairment in other important areas of functioning. Chronic hair pulling (along with motor and phonic tics) is also one of the symptoms of Tourette syndrome, which is a disease of the nervous system. However, most patients with trichotillomania do not have detectible neurological disorders.

Hair pulling can occur on any part of the body where hair grows. The most common area of hair pulling is the scalp. Hair pulling is divided two types focused pulling and nonfocused (or automatic) pulling. Focused pulling is an intentional act to control aversive feelings. Nonfocused pulling is generally a habitual type of pulling. Patients in dermatological clinics largely are in the latter group. Some patients show both subtypes of hair pulling together or with various overlapping behaviors. However, hair pulling also can occur on the eyebrows, eyelashes, pubic region, and any other area of the body with hair. The alopecia that results from hair pulling can range from small undetectable areas of hair loss to total baldness. Pulling hairs from other objects or people: Occasionally, patients may engage in hair pulling or plucking from other people, pets, dolls, or other fibrous materials (eg, carpets). In trichotemnomania, a rare condition, the scalp looks like an alopecia totalis but all follicle openings are uniformly filled with hair material. The condition is an obsessive-compulsive habit of cutting or shaving the hair and is different from trichotillomania. Habit reversal training (HRT), a cognitive behavioral therapy, has been successfully used in the treatment of trichotillomania. selective serotonin reuptake inhibitors (SSRIs) are commonly given to improve symptoms. Prozac is a common SSRI. Drugs in this class given to treat trichotillomania in children include sertraline (Zoloft), fluvoxamine (Luvox), and clomioramine.

Causes of Trichotillomania

Common causes and risk factors of Trichotillomania

• Serotonin deficiency:
• Structural brain abnormalities.
• Abnormal brain metabolism.
• Psychological theories.
• Childhood trauma.
• Stressful events.
• Neurochemical imbalance.

Signs and Symptoms of Trichotillomania

Sign and symptoms of Trichotillomania

• Hair loss.
• Increasing sense of tension.
• Hair pulling leads to an uneven appearance
• Bare patches or diffuse (all across) loss of hair
• Hair regrowth in the bare spots feels like stubble.

Treatment of Trichotillomania

Common Treatment of Trichotillomania

• Habit reversal training (HRT), a cognitive behavioral therapy, has been successfully used in the treatment of trichotillomania.
• selective serotonin reuptake inhibitors (SSRIs) are commonly given to improve symptoms. Prozac is a common SSRI. Drugs in this class given to treat trichotillomania in children include sertraline (Zoloft), fluvoxamine (Luvox), and clomioramine.
• Cognitive behavioral treatment is increasingly being reported as more effective than the combination of psychotherapy and pharmacological therapy. The author recommends that dermatologists be familiar with the treatment.
• Stimulus Control is a well-known behavioral treatment that in the case of trichotillomania, seeks to help sufferers first identify, and then eliminate, avoid, or change the particular activities, environmental factors, states, or circumstances that trigger hair pulling.