Recent advances in the treatment of trichotillomania (hair‐pulling disorder)

Abstract

Trichotillomania (TTM) is a condition in which affected individuals pull out their hair resulting in hair loss. This disorder affects roughly 0.5% to 2.0% of the population and can have significant psychological morbidity. Behavioral therapy has been used with success in the treatment of TTM, but not all patients are willing or able to comply with this treatment strategy. There is a need for effective pharmacological treatment options. Historically, pharmacotherapy for TTM has been inadequate in most cases, but recent advances have been made in this regard. Fluoxetine, clomipramine, olanzapine, and naltrexone have all been used in the treatment of TTM, but evidence of benefit has varied, and side effect profiles can limit practical utility. Recent advances in the understanding of the pathophysiology of TTM, as well as evidence of benefit seen with some glutamate-modulating agents such as N-acetylcysteine and dronabinol, have provided newer potential pharmacotherapy options.

Trichotillomania: What Do We Know So Far?

“…The main variants of trichotillomania include trichoteiromania, trichotemnomania, trichodaganomania, telogen mania, and trichophobia [10, 11].…”

“…This is usually associated with skin dryness and itching conditions, such as lichen simplex chronicus. Clinically, it presents as single or multiple irregular patches of alopecia, with scaling, lichenification, and hair breakage [10, 12]. Trichoscopic findings of trichoteiromania include proximal trichorrhexis nodosa and “broom hairs” which are broken hair shafts longitudinally split into 2 or 3 parts.…”

“…Trichoscopic findings of trichoteiromania include proximal trichorrhexis nodosa and “broom hairs” which are broken hair shafts longitudinally split into 2 or 3 parts. Broken hair shaft with different lengths, perifollicular scaling, and erythema can also be seen [10].…”

“…Patients with this condition show signs of shaving or hair-cutting in the affected areas with an otherwise healthy-appearing scalp. Trichoscopic examination of trichotemnomania may show short, broken, nonvellus hairs, without a decrease in follicle density, exclamation mark hairs, yellow dots, or black dots [10].…”

“…Due to the method of hair removal, the scalp is not involved in trichodaganomania, and affected areas are generally accessible sites such as the dorsal forearms. Microscopic features of examined hair may show a smooth blunted shaft at the bite site and a lack of attached root sheaths or hair bulbs, as would be seen in trichotillomania [10].…”