Trichotillomania Follow-up

  • Author: Carly A Elston; Chief Editor: William D James, MD   more...
 
Updated: Aug 26, 2011
 

Prognosis

In very young children, the prognosis is excellent.

In late childhood and adolescence, the prognosis is usually good but should be considered guarded. The alopecia quite often continues for months or a couple of years and then recurs after a variable time.

In adult patients, the prognosis is poor and permanent recovery is uncommon.

 
Contributor Information and Disclosures
Author

Carly A Elston  The Commonwealth Medical College

Disclosure: Nothing to disclose.

Coauthor(s)

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard Sperling, MD  Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors CH Rhee, MD, and Chull-Wan Ihm, MD, to the development and writing of this article.

References

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A geometric patch of incomplete alopecia in a teenage boy.
An 11-year-old girl shows a bizarre-patterned lesion covered with short hairs (not bald).
Another typical geometric shape of trichotillomania in a 7-year-old boy. Smooth baldness of the scalp surface at this age is rare.
In eyebrow involvement, the geometrical shape is not made.
Sometimes, the alopecia shows just a deficient volume of hair, as is the case in this 9-year-old girl.
When the entire scalp is involved, trichotillomania looks like a keratinization disorder of hairs (eg, monilethrix).
Tonsure trichotillomania is named after monks in the Middle Ages whose hair was tonsured with keeping only marginal hairs like a hair band. In this patient hair is preserved only in posterior margin of her scalp.
The close-up picture of the lesion of usual trichotillomania shows combination of newly growing young hair, broken shafts, comedolike black dots, empty orifices and vellus or intermediate hairs.
A contrast card examination is very helpful to demonstrate the nature of the alopecia to the parents of trichotillomania children. It shows broken hairs and newly growing hairs with slender tips among long intact hairs.
A woman with severe long-standing lesions.
The close-up picture of severe long-standing lesion in which the hairs are regressed to vellus or intermediate-type hairs and the scalp is rather smooth.
Histopathologically trichomalacia (twisted pigmented soft cortex) with catagen follicles is the characteristic of trichotillomania with empty follicles.
 
 
 
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