Childhood Trichotillomania: A Case and a Review of the Available Evidence-Based Pharmacologic Therapies.

Abstract

1. Abstract Background: Trichotillomania is a self-induced psychocutaneous dermatosis that is considered an impulse control disorder associated with obsessive-compulsive features. The disorder is characterized alopecia caused by repetitive pulling of own hair which cause irregular shape areas, partially devoid of hair. Treatment of the condition is generally unsatisfactory, because the condition is commonly resistant to treatment and relapse is common. Patients and methods: The case of girl with persistent alopecia of several months despite several treatments by several dermatologists was studied. The available evidence-based pharmacologic therapies that can be useful for the child’s condition was reviewed. Results: A thirteen-year old girl was referred to pediatric psychiatry clinic at the Children Teaching Hospital of Baghdad Medical City because of persistent alopecia of several months despite several treatments by several dermatologists. The parents didn’t give clues to any a psychosocial stress in the family. Although the parents were finding at several occasions tufts of hair in the bed of girl when awakening her at the morning, they were surprised to learn that her condition is self-induced. The girl was rather shy and denied pulling her hair. Examination of her scalp showed irregular shape areas, partially devoid of hair suggesting trichotillomania. The patient was not from Baghdad and there was no pediatric psychiatry service in the province where she came from. It was not possible to the girl a cognitive behavioral therapy in a busy tertiary center, nor was this convenient to her family. The need for a pharmacologic therapy was clearly demanded. Review of the available research evidence suggests that monotherapy of trichotillomania is not consistently effective and combination of therapies is more likely to be successful. Conclusion: Trichotillomania remains a challenging psychiatric condition with no first- line medications universally approved. The available evidence suggests that monotherapy of trichotillomania is not consistently effective and combination of therapies is more likely to be successful. The combination of a safer antidepressant, clomipramine with a safer neuroleptic, risperidone with or without the addition of N-acetylcysteine represents the current evidence-based recommendation for the pharmacologic treatment of childhood trichotillomania.