|
Trichotillomania
The condition trichotillomania was first identified in 1889
by Hallopeau. Since then numerous medical reports have been published
from both dermatologists and psychologists. As the name suggests
trichotillomaina is based on an obsession with hair. People with
trichotillomaina tug and pluck their hair making bald patches
or sometimes areas of diffuse hair loss. The hair for plucking
is selected from other hair based on it being different in some
way, perhaps feeling rough to the touch or more curly than other
fibers. Once a bald area has been made it becomes even more enticing
to pull at the hair around it making the alopecia patch larger.
Sometimes the hair plucking is more generalized and looks like
a diffuse alopecia. This is generally a non-scarring non-inflammatory
form of hair loss although long term repeated plucking over several
years may result in a mild immune cell infiltrate and irreversible
scarring damage to some hair follicles (Olsen 1993).
Trichotillomania affects 2-3% of all people with hair loss making
it a fairly common condition. Studies have identified the scalp
as being the most commonly affected area. Approximately 70% of
cases involve scalp hair loss, 50% involve eyebrows and or eyelashes,
30% include pubic hair, 20% body hair, and about 10% involve facial
hair. As well as plucking the hair, affected individuals may then
chew or eat the hair. Hair eating is known as trichophagia while
hair chewing may result in hair balls (trichobezoars). About 40%
of cases involve hair chewing while 10% of affected individuals
eat their hair. Eating hair is rather unwise as it is very irritating
to the stomach and may lead to digestion problems and ulcers.
The affected individual is most often unaware of what they are
doing and arrive at the dermatology clinic complaining of hair
loss from an unknown cause. Dermatologists have been known to
resort to making a video of the individual to prove to them that
they are unconsciously plucking their hair. Trichotillomania can
affect both children and adults although the mean age of first
onset is 13 years. Both boys and girls are affected in childhood
but the adult version of trichotillomania almost always affects
women (Jaspers 1996).
Trichotillomaina is a neurobiological condition and may develop
in people with anxiety disorders or mood problems. This form of
hair loss is seen in many species, not just humans. In mice the
condition is called barbering and mice housed together under stressful
conditions may pull each others hair out. Certain mouse strains
are much more prone to barbering than others which suggests genetics
play a part in this condition. Parrots are a well known example
where a distressed parrot separated from its owner will start
to pluck its own feathers.
There are 2 treatment approaches, one from psychiatrists and
one from dermatologists. There is a degree a friction between
the two groups as psychiatrists regard hair pulling as a disorder
and dermatologists regard it as an alopecia and so their "domain".
Psychiatrists will naturally focus on psychology and exploring
why the child might have developed this habit. Treatment may involve
therapy and in adults can involve drugs. Dermatologists take a
more direct approach. Children with trichotillomania may be made
to wear gloves. The gloves stop the sensation of touch and this
makes it impossible for the person to identify suitable hairs
for plucking. Sometimes a child's hair may be covered with Vaseline
which makes it difficult to get hold of and unpleasant to the
touch. In extreme cases the scalp may be bandaged so the child
can't get at the bald area.
The prognosis for children is generally good - with treatment
they usually grow out of it. There is some importance in obtaining
successful treatment as repeated plucking of hair will gradually
destroy hair follicles to the degree that they will not grow properly
and may not even grow at all. However to reach this stage would
take several years of continuous hair pulling. At this stage the
condition becomes traumatic/traction alopecia and involves scar
tissue development in the hair follicle. Adults who develop trichotillomania
have a poor prognosis and are much less likely to respond to treatment.
Contact
organization addresses
Trichotillomania Learning Center
1215 Mission Street, Suite 2
Santa Cruz, CA 95060
Tel: 408 457 1004
Fax: 408 426 4383
E-mail: trichster@aol.com
Website: www.trich.org. The
Trichotillomania Learning Center, Inc, (TLC) is a national nonprofit
organization supported by memberships established in 1991 by a sufferer
of the condition to provide information, support, and referral resources
to all who inquire about the experience and treatment of compulsive
hair pulling. Contact this group for information on many trichotillomania
support groups in the USA and beyond.
Obsessive-Compulsive Foundation, Inc.
P.O. Box 70
Milford, Ct. 06460-0070
Tel: 203 878 5669
Fax: 203 874 2826
Info Line: 203 874 3843
E-mail: info@ocfoundation.org
Website: www.ocfoundation.org.
The Obsessive-Compulsive Foundation focuses on several disorders
one of which is trichotillomania.
|
