Trichotillomania in Children

Abstract

Background: Trichotillomania is an often underdiagnosed condition. Little is known about trichotillomania in childhood. We aimed to analyze the characteristics of children with trichotillomania to increase information on this condition. Methods: A retrospective study of an electronic database was performed in a tertiary children's hospital. Information from patients with trichotillomania was systematically classified under the categories ‘who', ‘what', ‘when', ‘where', ‘why', and ‘how'. Results: A total of 33 patients had a diagnosis of trichotillomania (28 females, 5 males; peak age between 3 and 4 years). Scalp involvement was most common and nail biting was observed in 5 patients. Only 51.5% of patients had parents who noticed their child's hairpulling. Hair on or under the bed was the most common clue suggesting that hairpulling occurred. Triggering factors identified in 16 children included physical appearance, family-related issues, school-related issues, and concurrent illness. The noninvasive hair pull test was negative in all children. There was a high non-follow-up rate, and treatment outcomes varied. Conclusion: A set of 6 specific questions, based on the ‘5Ws and 1H' principle, facilitates the gathering of important information on children with unexplained nonscarring hair loss and helps clinicians be cognizant of possible outcomes of trichotillomania. This will be especially useful to clinicians who are not familiar with this elusive condition.

The Dermoscopic “Pluck Out Sign” for Beard Trichotillomania

“…Not many papers have appeared in the dermatological literature [7,8,9]. In the case of a child with nonscarring alopecia of uncertain etiology, the differential diagnosis needs to explore other underlying causes of hair loss.…”

“…The majority of studies on TTM to date have focused primarily on adults and adolescents and indicate that the most common age of onset is pre- or early adolescence (9-13 years) [8]. However, it is known that TTM frequently occurs in early childhood and has been reported from as early as 12 months of age [8].…”

“…However, it is known that TTM frequently occurs in early childhood and has been reported from as early as 12 months of age [8]. A patient's age can influence the mechanism of his/her hair pulling.…”

“…A patient's age can influence the mechanism of his/her hair pulling. Two distinct types of hair pulling have been described for TTM: automatic and focused pulling [8]. Automatic pulling occurs outside of one's own awareness, while focused pulling, in contrast, occurs in awareness and in response to negative emotional states (stress, sadness, anger, or anxiety), intense thoughts or urges, or in an attempt to establish asymmetry [8].…”

“…Two distinct types of hair pulling have been described for TTM: automatic and focused pulling [8]. Automatic pulling occurs outside of one's own awareness, while focused pulling, in contrast, occurs in awareness and in response to negative emotional states (stress, sadness, anger, or anxiety), intense thoughts or urges, or in an attempt to establish asymmetry [8]. Children more often fall within the automatic category, and therefore, they do not recall the actual pulling but may admit to “playing with hair” or they may have been noted to pull out their hair in a trance-like, disengaged state [8].…”