Trichotillomania

This article is published for general information. It is not intended as an aid to self diagnosis. If you are suffering this condition, professional advice should be sought. The Society lists practitioners in some countries.

Symptoms: Thinning hair or balding patches which may present as:
i) red indurated or excoriated scalp with visible hair follicles.
ii) normal scalp bearing short hairs which have escaped epilation.

Trichotillomania is a rare form of alopecia caused by the recurrent uncontrolled self inflicted epilation of hair e.g. scalp hair, eyelashes, eyebrows or other body hair.

Scalp hair is most commonly involved. This may produce noticeable hair losses e.g.one or more bald patches or sparse hair covering over large areas of scalp.

General comment.

Patients may experience a sense of tension immediately before bouts of epilation, or when attempting to resist the behavior.
The act of epilation itself may promote:
i) Sensations of pleasure and gratification.
ii) Clinical distress initiated by the uncontrollability of the habit or the visible damage caused.

Aetiology

The onset in boys occurs at age 7-9 years, and in girls at age 10+. Females are generally more prone to the disease which may be associated with stress levels at home or at school.
Of concern to trichologists: scalp hairs repeatedly epilated may eventually fail to regrow.

Treatment

Stop doing it ! - which is far easier said than done.
Treatment should be directed at any identified underlying cause - not the symptom. Many children outgrow the habit without major intervention. With others the habit more seriously continues into adult life. There may be deep psychological implications in many such cases which could benefit from referral to a hospital specialist e.g. psychotherapy. In general recovery requires a willing patient.