eMedicine Specialties > Dermatology > Diseases of the Adnexa

Trichotillomania: Multimedia

Author: Chull-Wan Ihm, MD, Professor, Department of Dermatology, Chonbuk National University, Korea
Contributor Information and Disclosures

Updated: Aug 31, 2009

Multimedia

(Enlarge Image)

Media file 1: A geometric patch of incomplete alopecia in a teenage boy.

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A geometric patch of incomplete alopecia in a teenage boy.

(Enlarge Image)

Media file 2: An 11-year-old girl shows a bizarre-patterned lesion covered with short hairs (not bald).

[ CLOSE WINDOW ]

An 11-year-old girl shows a bizarre-patterned lesion covered with short hairs (not bald).

(Enlarge Image)

Media file 3: Another typical geometric shape of trichotillomania in a 7-year-old boy. Smooth baldness of the scalp surface at this age is rare.

[ CLOSE WINDOW ]

Another typical geometric shape of trichotillomania in a 7-year-old boy. Smooth baldness of the scalp surface at this age is rare.

(Enlarge Image)

Media file 4: In eyebrow involvement, the geometrical shape is not made.

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In eyebrow involvement, the geometrical shape is not made.

(Enlarge Image)

Media file 5: Sometimes, the alopecia shows just a deficient volume of hair, as is the case in this 9-year-old girl.

[ CLOSE WINDOW ]

Sometimes, the alopecia shows just a deficient volume of hair, as is the case in this 9-year-old girl.

(Enlarge Image)

Media file 6: When the entire scalp is involved, trichotillomania looks like a keratinization disorder of hairs (eg, monilethrix).

[ CLOSE WINDOW ]

When the entire scalp is involved, trichotillomania looks like a keratinization disorder of hairs (eg, monilethrix).

(Enlarge Image)

Media file 7: 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.

[ CLOSE WINDOW ]

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.

(Enlarge Image)

Media file 8: 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.

[ CLOSE WINDOW ]

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.

(Enlarge Image)

Media file 9: 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.

[ CLOSE WINDOW ]

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.

(Enlarge Image)

Media file 10: A woman with severe long-standing lesions.

[ CLOSE WINDOW ]

A woman with severe long-standing lesions.

(Enlarge Image)

Media file 11: 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.

[ CLOSE WINDOW ]

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.

(Enlarge Image)

Media file 12: Histopathologically trichomalacia (twisted pigmented soft cortex) with catagen follicles is the characteristic of trichotillomania with empty follicles.

[ CLOSE WINDOW ]

Histopathologically trichomalacia (twisted pigmented soft cortex) with catagen follicles is the characteristic of trichotillomania with empty follicles.

More on Trichotillomania

Overview: Trichotillomania

Differential Diagnoses & Workup: Trichotillomania

Treatment & Medication: Trichotillomania

Follow-up: Trichotillomania

Multimedia: Trichotillomania

References

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References

Chamberlain SR, Odlaug BL, Boulougouris V, Fineberg NA, Grant JE. Trichotillomania: neurobiology and treatment. Neurosci Biobehav Rev. Jun 2009;33(6):831-42. [Medline].
Salaam K, Carr J, Grewal H, Sholevar E, Baron D. Untreated trichotillomania and trichophagia: surgical emergency in a teenage girl. Psychosomatics. Jul-Aug 2005;46(4):362-6. [Medline].
Keren M, Ron-Miara A, Feldman R, Tyano S. Some reflections on infancy-onset trichotillomania. Psychoanal Study Child. 2006;61:254-72. [Medline].
Stein DJ, Christenson GA. Trichotillomania:Descriptive characteristics and phenomenlogy. In: Stein DJ, Christenson GA, Hollander E. Trichotillomania. 1. 1st. Washington,DC: American Psychiatric Press,Inc.; 1999:1-41/1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. 4^th ed. Washington, DC: American Psychiatric Publishing; 2000.
Christenson GA, Pyle RL, Mitchell JE. Estimated lifetime prevalence of trichotillomania in college students. J Clin Psychiatry. Oct 1991;52(10):415-7. [Medline].
Mansueto CS, Thomas AM, Brice AL. Hair pulling and its afftective correlates in an African-American university sample. J Anxiety Disord. 4/2007;21:590-9.
Diefenbach GJ, Tolin DF, Hannan S, Crocetto J, Worhunsky P. Trichotillomania: impact on psychosocial functioning and quality of life. Behav Res Ther. Jul 2005;43(7):869-84. [Medline].
Murphy C, Redenius R, O'Neill E, Zallek S. Sleep-isolated trichotillomania: a survey of dermatologists. J Clin Sleep Med. Dec 15 2007;3(7):719-21. [Medline].
Radmanesh M, Shafiei S, Naderi AH. Isolated eyebrow and eyelash trichotillomania mimicking alopecia areata. Int J Dermatol. May 2006;45(5):557-60. [Medline].
Reeve EA, Bernstein GA, Christenson GA. Clinical characteristics and psychiatric comorbidity in children with trichotillomania. J Am Acad Child Adolesc Psychiatry. Jan 1992;31(1):132-8. [Medline].
Lee YJ, Ihm CW. Clinical observation of 69 cases of trichotillomania. Korean J Dermatol. 2005;43:567-75.
Koblenzer CS. Psychoanalytic Perspectives on Trichotillomania. In: Stein DJ, Christenson GA, Hollander E. Trichotillomania. 1. 1st. Washington,DC: American Psychiatric Press,Inc.; 1999:125-145/5.
Randall W. Grooming reflexes in the cat: endocrine and pharmacological studies. Ann N Y Acad Sci. 1988;525:301-20. [Medline].
Ihm CW, Han JH. Diagnostic value of exclamation mark hairs. Dermatology. 1993;186(2):99-102. [Medline].
Bloch MH, Landeros-Weisenberger A, Dombrowski P, Kelmendi B, Wegner R, Nudel J. Systematic review: pharmacological and behavioral treatment for trichotillomania. Biol Psychiatry. Oct 15 2007;62(8):839-46. [Medline].
Papadopoulos AJ, Janniger CK, Chodynicki MP, Schwartz RA. Trichotillomania. Int J Dermatol. May 2003;42(5):330-4. [Medline].
Rothbaum BO, Ninan PT. Manual for the cognitive-behavioral treatment of trichotillomania. In: Stein DJ, Chistenson GA, Hollander E, eds. Trichotillomania. Washington, DC: APA Press; 1999:263-84.
Keuthen NJ, Aronowitz B, Badenoch J. Behavioral treatment for trichotillomania. In: Stein DJ, Chistenson GA, Hollander E, eds. Trichotillomania. Washington, DC: APA Press; 1999:147-66.
Anthony WZ. Brief intervention in a case of childhood trichotillomania by self-monitoring. J Behav Ther Exp Psychiat. 1978;9:173-5.
Rahman O, Toufexis M, Murphy TK, Storch EA. Behavioral Treatment of Trichotillomania and Trichophagia in a 29-Month-Old Girl. Clin Pediatr (Phila). May 29 2009;[Medline].
Swedo SE, Leonard HL, Rapoport JL, Lenane MC, Goldberger EL, Cheslow DL. A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling). N Engl J Med. Aug 24 1989;321(8):497-501. [Medline].
[Guideline] Connolly SD, Bernstein GA. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. Feb 2007;46(2):267-83. [Medline].
[Best Evidence] Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study. Arch Gen Psychiatry. Jul 2009;66(7):756-63. [Medline].
Azrin NH, Nunn RG. Habit Control in a Day. New York, NY: Simon & Schuster; 1978.
Begotka AM, Woods DW, Wetterneck CT. The relationship between experiential avoidance and the severity of trichotillomania in a nonreferred sample. J Behav Ther Exp Psychiatry. Mar 2004;35(1):17-24. [Medline].
Christenson GA, Mackenzie TB, Mitchell JE. Characteristics of 60 adult chronic hair pullers. Am J Psychiatry. Mar 1991;148(3):365-70. [Medline].
Flessner CA, Conelea CA, Woods DW, Franklin ME, Keuthen NJ, Cashin SE. Styles of pulling in trichotillomania: exploring differences in symptom severity, phenomenology, and functional impact. Behav Res Ther. Mar 2008;46(3):345-57. [Medline].
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Mansueto CS, Stemberger RM, Thomas AM, Golomb RG. Trichotillomania: a comprehensive behavioral model. Clin Psychol Rev. 1997;17(5):567-77. [Medline].
Muller SA. Trichotillomania: a histopathologic study in sixty-six patients. J Am Acad Dermatol. Jul 1990;23(1):56-62. [Medline].
Muller SA, Winkelmann RK. Trichotillomania. A clinicopathologic study of 24 cases. Arch Dermatol. Apr 1972;105(4):535-40. [Medline].
Song IM, Ihm CW. Clinicohistopathologic analysis of 28 cases of trichotillomania. Korean J Dermatol. 1997;35(6):1101-9.
Sperling LC, Lupton GP. Histopathology of non-scarring alopecia. J Cutan Pathol. Apr 1995;22(2):97-114. [Medline].
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Woods DW, Flessner C, Franklin ME, et al. Understanding and treating trichotillomania: what we know and what we don't know. Psychiatr Clin North Am. Jun 2006;29(2):487-501, ix. [Medline].

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Keywords

trichotillomania, hair pulling, morbid hair pulling, hair-related psychosis, alopecia, psychotic alopecia, self-induced primary psychiatric disorders, self-induced psychiatric disorder, traumatic alopecia, hair loss, trichotillosis, trichomalacia

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Contributor Information and Disclosures

Author

Chull-Wan Ihm, MD, Professor, Department of Dermatology, Chonbuk National University, Korea
Chull-Wan Ihm, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

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.

Managing Editor

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.

CME Editor

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

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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eMedicine Specialties > Dermatology > Diseases of the Adnexa

Trichotillomania: Multimedia

Multimedia

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.

More on Trichotillomania

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor