EpistemisTrichotillomania
Specialty: Psychiatry.
Why it occurs
- Obsessive-compulsive disorder and related disorders
- Generalized anxiety disorder
- Maladaptive response to childhood stress or trauma
- Autism spectrum disorder (self-stimulatory behaviors/stereotypies)
- Borderline personality disorder
Initial workup
Dermatological examination of the scalp (to rule out alopecia areata, tinea capitis or other dermatoses); skin biopsy if diagnostic doubts persist (will reveal empty follicles and perifollicular hemorrhage without inflammation); ultrasound or abdominal CT if trichobezoar is suspected.
red flags
Ingestion of plucked hair (trichophagia) that causes the formation of a giant trichobezoar (Rapunzel syndrome), characterized by a palpable abdominal mass, persistent vomiting and intestinal obstruction.
Standard management
- N-acetylcysteine — NAC) (glutamate modulating antioxidant, has demonstrated significant efficacy at doses of 1200-2400 mg/day
- Olanzapine or Aripiprazole at low doses — adjuvants to reduce motor impulsivity
- Clomipramine — tricyclic antidepressant with good response in impulse control related to OCD
- Fluoxetine — SSRI to treat anxiety-depressive comorbidity
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 5
- Treatment options
- 4