Complicated Trichotillomania of a Trichobezoar about a Clinical Case

Abstract

Trichotillomania refers to a repetitive behavior which consists of pulling out one's own hair, sometimes to the point of depilation of entire areas of the scalp, resulting in obvious alopecia. People with trichotillomania may play with and/or ingest the pulled hairs; This is trichophagia. The prevalence of this disorder is difficult to estimate, varying depending on the authors and the criteria used in the studies. This disorder is quite common and affects, according to studies, approximately 1 to 2% of the population, preferably women, children and adolescents. We illustrate a clinic for trichotillomania, associated with trichophagia, through the case of a 7-year-old girl. She had consulted a pediatrician and dermatologist previously and was treated as a case of alopecia areata because a mother would conceal her history due to the stigma attached. Due to severe abdominal pain she was referred to a surgeon where detailed examinations revealed the trichobezoar, caused by hair agglomeration linked to repeated hair pulling and ingestion behaviors. The initial management of the disorder is surgical, before referral to child psychiatry. Overall, various psychosocial factors that precipitate and perpetuate the pathology of trichotillomania must be taken into consideration and treated appropriately. The importance and severity of the medical complications of trichotillomania should not be underestimated. Awareness of the disorder as well as greater interdepartmental collaboration would help in early diagnosis and appropriate management.