Trichotillomania

Background

• A repetitive hair-pulling disorder, often associated with skin-picking
• Classified as an impulse control disorder

Clinical Features

• Presents with bald spots in various sites: scalp, face, arms, legs, and pubic areas
• Scalp is the most common, usually with associated eyebrow and eyelash involvement
• Usually with bizarre-shaped patches of alopecia and different hair lengths due to breaking off at different points

Differential Diagnosis

• Tinea capitis
• Alopecia areata
• Monilethrix

Diagnosis

• DSM 5 Criteria:
  • Recurrent pulling out of one's hair, resulting in hair loss
  • Repeated attempts to decrease or stop hair pulling
  • The hair pulling causes significant distress and impairment in at least one important area of functioning
  • The hair pulling or hair loss is not attributable to another medical condition
  • The hair pulling is not better explained by the symptoms of another mental disorder (eg, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder)

• Skin biopsy can be used to exclude other etiologies of hair loss

Management

• Cognitive and behavioral psychotherapy is preferred over pharmacotherapy

Disposition

• Referral to psychiatry

References

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