Details

Autor(en) / Beteiligte

• Trotter, Shannon C
• Sampath, Suchita

Titel

10-Year-Old Female with an Irregularly Shaped Patch of Hair Loss

Ist Teil von

• Clinical Cases in Alopecia, 2023, p.25-30

Ort / Verlag

Switzerland: Springer International Publishing AG

Erscheinungsjahr

2023

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Trichotillomania is a type of alopecia with a psychiatric etiology. This condition is characterized by repeated hair pulling resulting in hair loss that typically presents as irregular, patchy areas with numerous broken hairs. Diagnosis of trichotillomania is clinical, but a biopsy can be used to aid in diagnosis. The pathophysiology of trichotillomania is not fully understood but appears to have a genetic component. The HOXB8 gene may play a role. In addition, the SAPAP3 gene, which codes for postsynaptic components of glutamatergic synapses, has been studied and shown to possibly contribute to hair-pulling behaviors. Trichotillomania may simultaneously present with trichophagia which may lead to the development of trichobezoars in severe cases. Other complications include secondary infection at the site of hair-pulling. Trichotillomania is often associated with multiple different psychiatric comorbidities such as concurrent or past depression, anxiety, substance use disorder, and obsessive-compulsive disorder. Treatment of trichotillomania addresses the underlying psychological triggers of hair-pulling behaviors. Management varies based on the patient’s age. In pre-school age children, trichotillomania is likely to self-resolve with time. In school-aged children, behavioral therapy is more effective than pharmacologic therapy. First-line behavioral therapy consists of habit reversal training and stimulus control techniques. In adolescents and adults, combination therapy utilizing pharmacotherapy, psychotherapy, and management of comorbid psychiatric disorders suggests the highest clinical efficacy. First-line pharmacotherapy for trichotillomania is fluoxetine or clomipramine. Second-generation antipsychotics have moderate evidence of benefit in the management of trichotillomania. N-acetylcysteine and dronabinol are newer therapies being studied in the treatment of trichotillomania and evidence points toward potential clinical benefit. Other emerging treatment options such as the antioxidant milk thistle, probiotics, and inositol demonstrate a possible future direction of trichotillomania management; however, evidence of clinical benefit is significantly limited.