Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder

Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.

Trichotillomania Triggered by Vitamin D Deficiency and Resolving Dramatically With Vitamin D Therapy.

Trichotillomania (TTM) is a disorder characterized by the individual pulling out his hair in a repetitive manner, resulting in significant hair loss, a feeling of tension before the hair pulling, and pleasure during it. Our understanding of the neurobiological basis of TTM is limited. However, the condition in all likelihood involves multiple pathways and a complex interaction between various genetic, psychological, and social factors. Vitamin D deficiency is thought to be linked to rickets in children and to a range of different diseases in adults, including osteoporosis, osteomalacia, cardiovascular diseases, cancer, dermatological diseases, and psychiatric disorders. We report a case of a 4-year-old girl with TTM triggered by vitamin D deficiency resolving dramatically with vitamin D therapy.

A trichobezoar in a child with undiagnosed celiac disease: a case report.

Celiac disease is a chronic, immune-mediated enteropathy caused by a permanent sensitivity to ingested gluten cereals that develops in genetically susceptible individuals. The classic presentation of celiac disease includes symptoms of malabsorption but has long been associated with cognitive, emotional, and behavioral disorders. We describe an 8-year-old patient with non-scarring alopecia and diagnosed with trichotillomania. Furthermore, she presented with a 3-year history of poor appetite and two or three annual episodes of mushy, fatty stools. Laboratory investigations showed a normal hemoglobin concentration and a low ferritin level. Serologic studies showed an elevated tissue immunoglobulin G anti-tissue transglutaminase level. A duodenal biopsy showed subtotal villous atrophy and crypt hyperplasia, and a large gastric trichobezoar was found in the stomach. Immediately after beginning a gluten-free diet, complete relief of trichotillomania and trichophagia was achieved. In this report, we describe a behavioral disorder as a primary phenomenon of celiac disease, irrespective of nutritional status.

How to diagnose hair loss.

This review presents a systematic approach to the diagnosis of hair loss. An accurate diagnosis is based on history, clinical examination, laboratory tests, and scalp biopsy. Whether the hair loss is a cicatricial or noncicatricial alopecia guides one's history taking. After assessing the patient's global appearance, the hair and scalp are evaluated, aided by a hair pull, hair tug, Hair Card, and hair mount. Scalp biopsies can confirm a diagnosis and are essential in all cases of cicatricial alopecia. In all patients with hair loss a complete blood count, ferritin, thyroid stimulating hormone, and vitamin D 25OH should be ordered.

Tricotilomanía: abordaje diferenciado según la franja etaria en la infancia / Trichotillomania: differentiated approach depending on the age group in children

Introducción: La tricotilomanía se caracteriza por áreas de alopecia causadas por la tracción de cabellos realizada por el mismo paciente y es más frecuente en edades pediátricas. No obstante, existen pocos trabajos sobre esta enfermedad. Este estudio tiene como objetivo delinear las características clínicas y evolutivas de la tricotilomanía en un grupo de niños Resultados: Hubo 47 casos de tricotilomanía, de los cuales 32 (68%) fueron niñas. Se observó una mayor predisposición en el género femenino luego de los 5 años (mientras en las menores de 5 años el 56% estuvo afectada, en las mayores de 5 años el porcentaje se elevó al 76%). La edad media de inicio fue de 6 años, variando entre los 7 meses y los 11 años. La presencia de factores precedentes como cambios en la dinámica familiar, problemas psicológicos y enfermedades se determinó en 29 pacientes y fue más común en los niños mayores de 5 años. La región parieto-temporal fue la más afectada y las pestañas y cejas las menos comprometidas. En el 74% de los casos se inició tratamiento con placebo y se obtuvo una buena respuesta...

Introduction: Trichotillomania is characterised by alopecic areas caused by patients pulling out their hair. There are few works on this disease in the pediatric age group. The aim of this study is to delineate the clinical characteristics and evolution of trichotillomania in childhood.Results: There were 47 cases, 32 (68%) girls, with a higher difference between genders was observed over the age of 5 (of the group of under 5, 56% were while over this age they represented the 76%). Median age at onset was 6 years, ranging from 7 months to 11 years. Prior factors such as changes in family dynamics, psychological problems and diseases occurred in 29 patients, more current in the over 5 years old. The parieto-temporal region was the most affected and eyelashes and eyebrows the least removed. Placebo treatment was instituted in 74% with good response...

Tricotilomania: [revisão] / Trichotillomania: [review]

CONTEXTO: Relatada desde a Antiguidade, a tricotilomania (TTM) somente na última década despertou maior interesse clínico, sendo incluída no DSM-IV-TR (The Diagnostic and Statistical Manual of Mental Disorders 4th Text Revision) como um transtorno do controle dos impulsos não especificado. Dados recentes estimam uma prevalência em torno de 3 por cento, indicando uma incidência mais comum do que se imaginava. Aspectos clínicos e terapêuticos ainda não estão totalmente definidos. OBJETIVO: Revisão sistemática da literatura de vários aspectos da tricotilomania pertinentes à teoria clínica e prática. MÉTODO: Os termos "trichotillomania", "epidemiology", "clinical characteristics", "etiology", "comorbidity" e "treatment" foram consultados nas bases de dados Medline/PubMed, Lilacs, PsycINFO e Cochrane Library. RESULTADOS: Pesquisas com populações não clínicas sugerem que a TTM é mais comum do que se acreditava. Aspectos fenomenológicos, taxonômicos, comorbidades e possibilidades terapêuticas são discutidos. CONCLUSÃO: Apesar de um crescente número de estudos recentes, questões clínicas e terapêuticas permanecem em aberto. Com base nesta revisão da literatura, sugerem-se direções para diagnóstico, tratamento e futuras pesquisas.

BACKGROUND: Recognized since antiquity, only within the last decade has the subject of trichotillomania provoked any larger clinical interest since it has been included in the DSM-IV-TR (The Diagnostic and Statistical Manual of Mental Disorders 4th Text Revision) as a disturbance of the impulse-control disorders not elsewhere classified. Recent data estimates its prevalence at around 3 percent. Although more common than it was imagined before, clinical and therapeutic aspects are still not well defined. OBJECTIVE: Systematic revision in the literature of several aspects of trichotillomania and its clinical and practical theory. METHOD: The term "trichotillomania", "its epidemiology", "clinical characteristics", "etiology", "comorbidity" and "treatment" were searched in the data bases of Medline/ PubMed, Lilacs, PsycINFO and Cochrane Library. RESULTS: Research with no clinical populations suggests that TTM is more common than it was previously suspected. Phenomenological and taxonomical aspects, comorbidity as well as therapeutic possibilities are discussed. CONCLUSION: Despite a growing number of recent studies, clinical and therapeutic aspects remain undefined. Based on this literature's review, directions are suggested concerning diagnosis, treatment and future research.

Tricotilomania / Trichotillomania

A tricotilomania é caracterizada por alopecia, resultante de hábito repetitivo de puxar o cabelo exercido pelo próprio paciente. Além do comprometimento estético e conseqüências sociais, o hábito pode levar a complicações. O artigo procura familiarizar o leitor com os principais aspectos clínicos e o tratamento a ser utilizado nos casos de tricotilomania, com ênfase nas técnicas de terapia comportamental.

Trichotillomania is characterized by hair loss from a patient's repetitive self-pulling of hair. This habit is embarrassing, unattractive, socially undesirable, and can predispose to some complications. The purpose of this article is to familiarize the reader with clinical features of trichotillomania and to describe appropriate therapeutic approach to be applied, with particular attention to behavior therapy techniques.

Postoperative pressure-induced alopecia: report of a case and discussion of the role of apoptosis in non-scarring alopecia.

We report a case of postoperative pressure induced alopecia in a 21-year-old black female after multiple intraoperative procedures. The histopathology is distinctive and demonstrated features in common with trichotillomania and alopecia areata, including the presence of pigment casts, catagen follicles, melanophages and apoptotic bodies. External hair manipulation is considered the primary event in the etiology of pigment casts, however, our present case demonstrated numerous pigment casts despite a complete lack of evidence of external hair manipulation. We performed pattern analysis and in situ end-labeling in 19 cases of non-scarring alopecia. Pigment casts were seen in postoperative alopecia (1 case), alopecia areata (1 case) and trichotillomania (5 cases). These forms of alopecia have in common the sudden termination of the anagen phase of the hair cycle. When the anagen portion of the hair cycle is prematurely disrupted hairs enter into catagen. Pigment casts may represent a non-specific reaction pattern of follicles that are suddenly transformed from anagen to catagen. We therefore propose that hair manipulation is not uniquely responsible for the formation of pigment casts. The primary pathophysiology resulting in the formation of pigment casts more correctly reflects the sudden termination of the anagen phase of the hair cycle.

Trastornos del control de impulsos / Impulse control disorders

Se revisan las patologías incluidas en este grupo de trastornos, sus antecedentes históricos y principales teorías etiológicas. Se destacan los aspectos forenses y se incluyen algunos antecedentes nacionales

Tricotilomania: relato de um caso clínico / Trichotillomania: relate of a clinical case

É a tricotilomania um impulso irresistível de arrancar os cabelos. Tal estudo consiste de relato sobre um caso clínico de um paciente portador de tricotilomania, com uma abordagem teórica e conclusöes acerca do assunto

Traumatic alopecia in trichotillomania: a pathogenic interpretation of histologic lesions in the pilosebaceous unit.

Ten patients with traumatic alopecia (trichotillomania) were being investigated histologically and, in five of them, hairs from the affected scalp area were plucked out for direct microscopic examination. Some histologic features appear to be specific markers for traumatic alopecia: empty hair ducts, plucked out hair bulbs, clefts in hair matrix, catagen involution of empty outer root sheaths, Miescher's trichomalacia in the deep dermis and torn-off sebaceous glands. Other signs are unspecific, such as presence of catagen and anagen VI hairs, infundibular plugging, melanin in keratin plugs and in the dermal papilla. The relative frequency of the different histopathologic features was evaluated. When little clinical information is available, a diagnosis of traumatic alopecia can be supported by skin biopsy. The histologic picture of trichotillomania is always incomplete, depending upon factors such as intensity of pulling or/and time of biopsy after plucking.