Trichotillomania

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Trichotillomania

  1. 1. Trichotillomania Nargess Tavakoli Guilan University of Medical Sciences
  2. 2. <ul><li>Alopecia resulting from repetitive hair manipulations by the patient’s own hand </li></ul>
  3. 3. physiopathology <ul><li>A primary psychiatric disorder </li></ul><ul><li>One of traumatic alopecia </li></ul>
  4. 4. <ul><li>Age: Any / childhood </li></ul><ul><li>Sex: F>M </li></ul><ul><li>Depression ,anxiety </li></ul>
  5. 5. <ul><li>Head </li></ul><ul><li>Scalp frontotemporal </li></ul><ul><li>eyebrow </li></ul><ul><li>eyelash </li></ul>
  6. 7. <ul><li>Poor insight </li></ul><ul><li>sedentary activities </li></ul><ul><li>stroking, twisting, rubbing  pulling  Playing with the hair </li></ul>
  7. 8. <ul><li>Geometrical / Incomplete / Nonscarring ( typical) </li></ul><ul><li>Eyebrow / eyelash </li></ul><ul><li>A somewhat deficient volume of hair </li></ul>
  8. 9. A geometric patch of incomplete alopecia
  9. 10. Note the preservation of the hairline
  10. 11. bizarre-patterned lesion covered with short hairs (not bald).
  11. 12. Alopecia patch <ul><li>Single / multiple </li></ul><ul><li>Small / large </li></ul><ul><li>Except margin? </li></ul><ul><li>Whole scalp? Rare </li></ul>
  12. 13. magnifying glass <ul><li>(1) Newly growing short hairs </li></ul><ul><li>(2) Broken short hairs </li></ul><ul><li>(3) Vellus or indeterminate hairs </li></ul><ul><li>(4) Black dots </li></ul><ul><li>(5) Empty follicular orifices </li></ul>
  13. 14. black dots
  14. 15. <ul><li>Sometimes, although the hair thinning is apparent, the lesion is not well defined </li></ul>
  15. 16. <ul><li>Pull test  Neg. </li></ul><ul><li>Trichogram  In areas of re growing hairs 100% anagen </li></ul>
  16. 17. Diagnosis <ul><li>A high index of suspicion for the diagnosis is essential </li></ul><ul><li>Biopsy? </li></ul>
  17. 18. Treatment <ul><li>Consult a psychiatrist </li></ul><ul><li>Clomipramine </li></ul><ul><li>Fluxetin </li></ul><ul><li>Pimozide </li></ul>
  18. 19. Prognosis <ul><li>Very young children  excellent. </li></ul><ul><li>Late childhood & adolescence  usually good </li></ul><ul><li>Adults  poor </li></ul>

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