Alopecia from chronic hair pulling, called trichotillomania, occurs in children, adolescents, and adults. Trichotillomania can cause embarrassment and physical disfigurement, but many trichotillomania sufferers refuse to disclose that they pull their hair and avoid health care encounters. Behaviors such as hair twirling, hair examination, and eating or putting hair into the mouth are also associated with the condition.
Patients may pull different areas of body hair, which results in irregular hair loss from the scalp, eyebrows, eyelashes, and pubic area. Infection of the hair follicle can cause cellulitis or conjunctivitis with scarring and permanent hair loss. Patients who wear wigs or false eyelashes or whose eyebrows are penciled in may suffer from the condition.
Rule out the following conditions when considering a trichotillomania diagnosis: tinea capitus, endocrinopathies, lymphomas, atopic dermatitis, male pattern baldness, drug-induced alopecia, nutritional de ficiencies, or traction alopecia from hairstyling.
If you suspect trichotillomania, ask the patient about the hair loss. Patients willing to discuss their condition often describe heightened tension before hair pulling and pleasure or relief ofterward. Educating the patient about the condition helps reduce stigma.
Experts consider trichotillomania an impulse control disorder; therefore, you should determine if patients have comorbid conditions such as depression, anxiety, or obsessive-compulsive disorder. Treat patients with selective serotonin reuptake inhibitors and behavioral therapies or hypnosis. You may need to refer patients to a mental health professional specializing in trichotillomania. The Trichotillomania Learning Center, 831-457-1003 or http://www.trich.org can provide general and referral information.
Heather Whittaker, FNP, MSN
Karen Wolf, ANP, PhD
Nancy Keuthen, PhD
Copyright Springhouse Corporation Feb 2002
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