Published on 16/03/2015 by admin
Filed under Dermatology
Last modified 16/03/2015
This article have been viewed 1381 times
Leslie G. Millard
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
The term trichotillomania was first used by Hallopeau in 1889 and is derived from the Greek thrix (hair), tillein (to pull out) and mania (madness). Psychiatric classification (ICD 10: F63.3 F68.1; DSM-IV-TR 312.30) lists trichotillomania under impulse-control disorders. Now the definition must encompass a broader spectrum of additional psychopathologies, such as obsessive–compulsive disorder, and mood disorders. The revised diagnostic criteria for trichotillomania include the following:
Recurrent pulling out of one’s own hair resulting in hair loss
An increasing sense of tension immediately before pulling out the hair or when attempting to resist this behaviour
Pleasure, gratification or relief when pulling out the hair
The disturbance is not better accounted for by another mental disorder
The disturbance provokes clinically marked distress and/or impairment in occupational, social, or other areas of functioning.
The management must recognize the contribution of these psychopathologies and therefore centers on three issues. First, the diagnosis of the hair defect; second, the diagnostic grouping and the presence of other psychiatric comorbidities such as depression; and third, the presence of complications such as trichobezoar, the formation of gastric and intestinal hair balls.
Trichotillomania is seen in both children and adults. The latter may also have additional classifiable psychiatric illnesses, which distorts any attempt to make this a homogeneous entity. There appear to be two distinct populations: firstly, those who present in childhood, mainly between the ages of 5 and 12 years, and secondly chronic cases presenting as adults who have continued hair-pulling activity from adolescence or who developed the disorder in early adult life. The early onset group show benign, self-limiting behavior and most are probably suffering from a habit disorder, perhaps as an extension of distracted tension relieving hair-twirling activity. Children may also display other habits such as nail biting, thumb sucking, skin picking, nose picking, lip biting, and cheek chewing. In children, there is an association with anxiety and dysthymia, learning disability, and iron deficiency.
The adolescent group is more likely to be female (ratios of up to 3.5 : 1). The psychopathology may be related to difficult parent relationships, schooling stress, especially bullying, and distress related to the onset of pubertal body image changes. Hidden physical and sexual abuse within the family contributes increasingly to the psychopathology. The adult age groups are associated with this greater psychopathology and show a distinct female preponderance (up to 15 : 1). This also remains true for different racial groups. There is a significant association of trichotillomania with obsessive–compulsive disorder and depressive illness.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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