Trichotillomania Nargess Tavakoli Guilan University of Medical Sciences

Alopecia resulting from repetitive hair manipulations by the patient’s own hand

Alopecia resulting from repetitive hair manipulations by the patient’s own hand

physiopathology A primary psychiatric disorder One of traumatic alopecia

A primary psychiatric disorder

One of traumatic alopecia

Age: Any / childhood Sex: F>M Depression ,anxiety

Age: Any / childhood

Sex: F>M

Depression ,anxiety

Head Scalp frontotemporal eyebrow eyelash

Head

Scalp frontotemporal

eyebrow

eyelash

Poor insight sedentary activities stroking, twisting, rubbing  pulling  Playing with the hair

Poor insight

sedentary activities

stroking, twisting, rubbing  pulling  Playing with the hair

Geometrical / Incomplete / Nonscarring ( typical) Eyebrow / eyelash A somewhat deficient volume of hair

Geometrical / Incomplete / Nonscarring ( typical)

Eyebrow / eyelash

A somewhat deficient volume of hair

A geometric patch of incomplete alopecia

Note the preservation of the hairline

bizarre-patterned lesion covered with short hairs (not bald).

Alopecia patch Single / multiple Small / large Except margin? Whole scalp? Rare

Single / multiple

Small / large

Except margin?

Whole scalp? Rare

magnifying glass (1) Newly growing short hairs (2) Broken short hairs (3) Vellus or indeterminate hairs (4) Black dots (5) Empty follicular orifices

(1) Newly growing short hairs

(2) Broken short hairs

(3) Vellus or indeterminate hairs

(4) Black dots

(5) Empty follicular orifices

black dots

Sometimes, although the hair thinning is apparent, the lesion is not well defined

Sometimes, although the hair thinning is apparent, the lesion is not well defined

Pull test  Neg. Trichogram  In areas of re growing hairs 100% anagen

Pull test  Neg.

Trichogram  In areas of re growing hairs 100% anagen

Diagnosis A high index of suspicion for the diagnosis is essential Biopsy?

A high index of suspicion for the diagnosis is essential

Biopsy?

Treatment Consult a psychiatrist Clomipramine Fluxetin Pimozide

Consult a psychiatrist

Clomipramine

Fluxetin

Pimozide

Prognosis Very young children  excellent. Late childhood & adolescence  usually good Adults  poor

Very young children  excellent.

Late childhood & adolescence  usually good

Adults  poor