June, 2004
Trichotillomania in childhood: case series and review.
Tay YK, Levy ML, Metry DW.
Department of Dermatology, Changi General Hospital, Singapore.
Trichotillomania is a relatively common cause of childhood alopecia. We report
our observations of 10 children with trichotillomania seen over a 2-year period
at Texas Children's Hospital.
Patient ages ranged from 9 to 14 years (mean: 11.3 years) with
an equal gender ratio. The duration of hair-pulling ranged from 1 month to 10
years (median: 4.6 months).
The scalp alone was affected in 8 cases, the scalp and eyelashes
in 1 case, and the eyelashes alone in 1 case.
The frontal scalp and vertex were the most common sites
affected. Associated findings included nail-biting in 2 cases, "picking" of the
skin in 1 case, and headaches in another case.
Noted precipitating factors in 3 patients included "stress" at
Hair Loss and school. Associated psychopathology included major depression in 1 case,
attention-deficit/hyperactivity disorder in 1 case, and an "anxious and nervous
personality" in 1 case.
The most important differential diagnosis to exclude from
trichotillomania is alopecia areata, which was seen concomitantly in 1 patient
and preceded the onset of hair-pulling by 11 months.
Eight patients were referred to a child psychologist for
additional management, of which 2 were subsequently treated with antidepressant
medication. Trichotillomania is a disorder of multifaceted pathology, and an
interdisciplinary approach to management is often helpful.
The common prepubertal age of onset provides an important
opportunity for the pediatrician to lend support to affected patients and their
families.
PMID: 15121993 [PubMed - in process]
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