Dermatology Oasis

Editor: Dr. Nameer Al-Sudany (IRAQ)

Trichotillomania

Trichotillomania

Trichotillomania (Hair-pulling habit)
* A minor comfort habit in children like nail-biting and lip-licking.
* A type of traumatic localized non-scarring alopecia not uncommonly seen in children.
* Occurs more in girls than in boys.
* Affected individuals seldom have major psychiatric disorders, however some may have obsessive compulsive neurosis and when they are under the influence of psychological tension they develop and accustom the habit of twisting and pulling their hair resulting in localized non-scarring alopecia.
* Commonly involved sites are the sides of the scalp and the fronto-vertical area.
* A very important diagnosis-aiding feature is that hairs in the affected area are usually broken at different lengths from the scalp surface.
* The diagnosis can usually be made on the history, but some parents do not know what is going on.
The main differential diagnoses are:
1. Alopecia areata
2. Traction alopecia
3. Tinea capitis

* The bald areas in trichotillomania do not show the exclamation-mark hairs of alopecia areata, or the scaling and inflammation of scalp ringworm. The patches are irregular in outline and hair loss is never complete.

Management:
1. Reassurance
2. Explanation to the parents or the patient that it is due to the habit of hair pulling.
3. Tranquilizers may be given.
4. Referral to psychiatrist may be necessary in some cases.

Prognosis: trichotillomania is usually of little consequence as the habit often goes away most quickly if it is ignored. However, more severe degrees of hair-pulling are occasionally seen in disturbed adolescents and in those with learning difficulties; then the outlook for full regrowth is less good, even with formal psychiatric help.

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