Hair‐pulling disorder (Trichotillomania): Etiopathogenesis, diagnosis and treatment in a nutshell

Abstract

Hair‐pulling disorder (Trichotillomania) is a disabling mental disorder. Patient's behavior is characterized by the recurrent pulling of own hair with hair loss and a marked dysfunction in various areas of daily life. Trichotillomania is a relatively common disorder with pediatric onset, often associated with significant morbidity, comorbidity, and functional decline. Surprisingly, children or adolescents have been little studied in the research studies on the pathophysiology and psychopathology of trichotillomania. Furthermore, more evidences regarding the effective and evidence‐based pharmacological interventions for the treatment of this condition are encouraged. This narrative review will report on the etiopathogenesis and clinical manifestations of trichotillomania including criteria for diagnosis and treatment issues of this complex mental disorder.

Alopecia areata: A psychodermatological perspective

“…As for differential diagnosis, many conditions can mimic AA as congenital hypotrichosis, 25 ectodermal dysplasias, 26 loose anagen hair, 27 alopecia triangularis, 28 cicatricial alopecia (aplasia cutis, morphea, pseudopelade of Brocq, and others), 29 tinea capitis (specially in children), 30,31 trichotillomania, 32‐34 friction alopecia, 35 traction alopecia, 36 pressure alopecia, 37 tick bite alopecia, 38 and syphilis 17,39 …”

“…It has been demonstrated in in vitro and studies on rodents that substance P stimulates neurogenic inflammation, catagen phase entrance, and collapse of the hair follicle immunological privilege, up-regulating the expression of histocompatibility molecules type I and β2-microglobulin. 24 As for differential diagnosis, many conditions can mimic AA as congenital hypotrichosis, 25 ectodermal dysplasias, 26 loose anagen hair, 27 alopecia triangularis, 28 cicatricial alopecia (aplasia cutis, morphea, pseudopelade of Brocq, and others), 29 tinea capitis (specially in children), 30,31 trichotillomania, [32][33][34] friction alopecia, 35 traction alopecia, 36 pressure alopecia, 37 tick bite alopecia, 38 and syphilis. 17,39 Several authors have associated AA with other autoimmune diseases such as thyroiditis, vitiligo, psoriasis, rheumatoid arthritis, and inflammatory bowel disease, among others.…”

Treatment of diseases associated with non-cicatricial alopecia

“…Cognitive behavioral therapy may be the treatment of choice in many cases. Habit-changing training can also be effective [27]. Pharmacotherapy is used in cases of reflex hair pull-nie, przy czym można wysunąć hipotezę, że leki do stosowania miejscowego znajdą zastosowanie głównie w przypadkach, kiedy leczenie ogólne nie jest wskazane [22].…”

“…N-acetylcysteine (600-2400 mg/day), clomipramine and olanzapine are most commonly recommended, but no drug has yet been approved for the treatment of trichotillomania. Topical glucocorticosteroids, capsaicin and anesthetics may be used as a supportive therapy [27,28].…”

“…trichotillomania Trichotillomania to zaburzenie polegające na wyrywaniu własnych włosów przez pacjenta. Leczeniem z wyboru w wielu przypadkach może być terapia poznawczo-behawioralna [27]. Skuteczny może być także trening zmiany nawyków.…”