Trichotillomania

Nargess Tavakoli

Guilan University of Medical Sciences

Alopecia resulting from repetitive hair

manipulations by the patient’s own hand

physiopathology

A primary psychiatric disorder

One of traumatic alopecia

• Age: Any / childhood

• Sex: F>M

• Depression ,anxiety

• Head

• Scalp frontotemporal

• eyebrow

• eyelash

• Poor insight

• sedentary activities

• stroking, twisting, rubbing pulling Playing with the 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

magnifying glass

• (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

• Pull test Neg.

• Trichogram In areas of re growing hairs 100% anagen

Diagnosis

• A high index of suspicion for the diagnosis is essential

• Biopsy?

Treatment

• Consult a psychiatrist

• Clomipramine

• Fluxetin

• Pimozide

Prognosis

• Very young children excellent.

• Late childhood & adolescence usually good

• Adults poor