Trichotillomania Medication

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

Medication Summary

Although currently no pharmacotherapy for trichotillomania is consistently effective, several recent studies show promise.

In a 12-week, double-blind, placebo-controlled trial, Grant et al assessed whether the glutamatergic agent N -acetylcysteine improved trichotillomania in adults (n = 50) with compulsive behavior. The dosage ranged from 1200-2400 mg/d. Improvement was measured by the Massachusetts General Hospital Hair Pulling Scale (MGH-HPS), the Clinical Global Impression-Improvement (CGI-I) scale, and the Psychiatric Institute Trichotillomania Scale. After 9 weeks of treatment, significantly greater reduction in hair-pulling symptoms (P = .001) was observed in patients taking N -acetylcysteine in both the MGH-HPS and the Psychiatric Institute Trichotillomania Scale.[26]

Grant et al have also assessed the efficacy of the cannabinoid dronabinol in treating trichotillomania in a small 12-week, open-label treatment study in female subjects (n = 12). The study showed that a dose of 11.6 ± 4.1 mg/d led to a decrease in the mean MGH-HPS from 16.5 ± 4.4 at baseline to 8.7 ± 5.5 at study endpoint (P = .001). Of subjects, 64.3% showed both a decrease in MGH-HPS and a rating of "much or very much" improved on the CGI-I scale, with no adverse effects on cognition.[27]

Van Ameringen et al studied the efficacy of flexible-dose olanzapine for the treatment of trichotillomania in a 12-week, randomized, double-blind, placebo-controlled trial. A dose of 10.8 ± 5.7 mg/d showed a significant decrease in the Yale-Brown Obsessive Compulsive Scale for Trichotillomania (P < .01) and the CGI-Severity of Illness scale (P < .001), with 85% of subjects receiving olanzapine showing improvement on the CGI-I scale. The drug appears to be both safe and effective.

Methylphenidate showed limited efficacy in trichotillomania patients with comorbid attention deficit-hyperactivity disorder (ADHD) and a low rate of stressful life events (SLEs) in a 12-week study by Golubchik et al.[31]

Case studies suggest that both oxcarbazepine and aripiprazole warrant further study as possible treatments for trichotillomania.[32, 33]

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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

  1. Chamberlain SR, Odlaug BL, Boulougouris V, Fineberg NA, Grant JE. Trichotillomania: neurobiology and treatment. Neurosci Biobehav Rev. Jun 2009;33(6):831-42. [Medline].

  2. 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].

  3. Keren M, Ron-Miara A, Feldman R, Tyano S. Some reflections on infancy-onset trichotillomania. Psychoanal Study Child. 2006;61:254-72. [Medline].

  4. 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.

  5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. 4th ed. Washington, DC: American Psychiatric Publishing; 2000.

  6. Christenson GA, Pyle RL, Mitchell JE. Estimated lifetime prevalence of trichotillomania in college students. J Clin Psychiatry. Oct 1991;52(10):415-7. [Medline].

  7. 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.

  8. 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].

  9. Flessner CA, Lochner C, Stein DJ, Woods DW, Franklin ME, Keuthen NJ. Age of onset of trichotillomania symptoms: investigating clinical correlates. J Nerv Ment Dis. Dec 2010;198(12):896-900. [Medline].

  10. 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].

  11. Radmanesh M, Shafiei S, Naderi AH. Isolated eyebrow and eyelash trichotillomania mimicking alopecia areata. Int J Dermatol. May 2006;45(5):557-60. [Medline].

  12. 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].

  13. Lee YJ, Ihm CW. Clinical observation of 69 cases of trichotillomania. Korean J Dermatol. 2005;43:567-75.

  14. 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.

  15. Randall W. Grooming reflexes in the cat: endocrine and pharmacological studies. Ann N Y Acad Sci. 1988;525:301-20. [Medline].

  16. Bienvenu OJ, Wang Y, Shugart YY, et al. Sapap3 and pathological grooming in humans: Results from the OCD collaborative genetics study. Am J Med Genet B Neuropsychiatr Genet. Jul 5 2009;150B(5):710-20. [Medline].

  17. Boardman L, van der Merwe L, Lochner C, et al. Investigating SAPAP3 variants in the etiology of obsessive-compulsive disorder and trichotillomania in the South African white population. Compr Psychiatry. Mar-Apr 2011;52(2):181-7. [Medline].

  18. Ihm CW, Han JH. Diagnostic value of exclamation mark hairs. Dermatology. 1993;186(2):99-102. [Medline].

  19. 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].

  20. Papadopoulos AJ, Janniger CK, Chodynicki MP, Schwartz RA. Trichotillomania. Int J Dermatol. May 2003;42(5):330-4. [Medline].

  21. 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.

  22. 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.

  23. Anthony WZ. Brief intervention in a case of childhood trichotillomania by self-monitoring. J Behav Ther Exp Psychiat. 1978;9:173-5.

  24. 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].

  25. Franklin ME, Edson AL, Ledley DA, Cahill SP. Behavior therapy for pediatric trichotillomania: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. Aug 2011;50(8):763-71. [Medline]. [Full Text].

  26. [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].

  27. Grant JE, Odlaug BL, Chamberlain SR, Kim SW. Dronabinol, a cannabinoid agonist, reduces hair pulling in trichotillomania: a pilot study. Psychopharmacology (Berl). May 19 2011;[Medline].

  28. Van Ameringen M, Mancini C, Patterson B, Bennett M, Oakman J. A randomized, double-blind, placebo-controlled trial of olanzapine in the treatment of trichotillomania. J Clin Psychiatry. Oct 2010;71(10):1336-43. [Medline].

  29. 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].

  30. [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].

  31. Golubchik P, Sever J, Weizman A, Zalsman G. Methylphenidate treatment in pediatric patients with attention-deficit/hyperactivity disorder and comorbid trichotillomania: a preliminary report. Clin Neuropharmacol. May-Jun 2011;34(3):108-10. [Medline].

  32. Leombruni P, Gastaldi F. Oxcarbazepine for the treatment of trichotillomania. Clin Neuropharmacol. Mar-Apr 2010;33(2):107-8. [Medline].

  33. Virit O, Selek S, Savas HA, Kokaçya H. Improvement of restless legs syndrome and trichotillomania with aripiprazole. J Clin Pharm Ther. Dec 2009;34(6):723-5. [Medline].

 
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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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