Trichotillomania: a case report with clinical and dermatoscopic differential diagnosis with alopecia areata

Pinto, Ana Cecília Versiani Duarte; Andrade, Tatiana Cristina Pedro Cordeiro de; Brito, Fernanda Freitas de; Silva, Gardênia Viana da; Cavalcante, Maria Lopes Lamenha Lins; Martelli, Antônio Carlos Ceribelli

doi:10.1590/abd1806-4841.20175136

Cited by 13 publications

(20 citation statements)

References 8 publications

(15 reference statements)

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“…Other features of tinea capitis reported in black scalp include black dots, hair casts, broken hairs, clip or question mark hairs, and Morse codeshaped hair [4,34,39,41]. Trichotillomania Few reports have been published about the trichoscopic characteristics of trichotillomania in dark skin [26,[42][43][44]. The honeycomb-like pigmented network is preserved and pinpoint white dots are regularly arranged [19,26].…”

Section: Tinea Capitismentioning

confidence: 99%

“…The honeycomb-like pigmented network is preserved and pinpoint white dots are regularly arranged [19,26]. The most important features include the presence of broken hairs of different lengths, short hairs with trichoptilosis (split ends), black dots, irregular coiled hairs, upright regrowing hairs, question mark hairs, flame hairs, the "V" sign, tulip hairs, and hair powder [26,[42][43][44][45]. Fig.…”

Section: Tinea Capitismentioning

confidence: 99%

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Trichoscopy of Dark Scalp

Ocampo‐Garza

Tosti

2018

Skin Appendage Disord

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Trichoscopy (dermoscopy of the hair and scalp) is a technique that improves diagnostic accuracy and follow-up with hair and scalp disorders. Although several studies of trichoscopy have been made in Caucasian and Asian populations, little has been published regarding trichoscopy findings in skin of color, despite the great prevalence of hair diseases in populations with this kind of skin. The aim of this review was to describe the trichoscopic features of normal scalp and of hair disorders in patients with dark skin phototypes. This will help dermatologists to distinguish between unique trichoscopic features of dark skin, and allow them to provide more accurate diagnoses and treatments for these patients.

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Section: Tinea Capitismentioning

confidence: 99%

Section: Tinea Capitismentioning

confidence: 99%

Trichoscopy of Dark Scalp

Ocampo‐Garza

Tosti

2018

Skin Appendage Disord

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“…The most recent report of NAC in the treatment of TTM was that of a 12‐year‐old female treated with a combination of doxepin, fluoxetine, pimozide, and 600 mg of NAC every 8 hours. This patient demonstrated progressive improvement of hair pulling while on this regimen …”

Section: Resultsmentioning

confidence: 81%

“…Of these, 15 were excluded, leaving 14 included papers. An additional case report in the references of an included article was found to meet inclusion criteria, leading to a total of 15 papers included in this review (Table ) …”

Section: Resultsmentioning

confidence: 99%

A review of N‐acetylcysteine in the treatment of grooming disorders

et al. 2019

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Background Pathologic grooming disorders can lead to clinically significant distress and functional impairment. Studies on treatment of these disorders with selective serotonin reuptake inhibitors (SSRIs) and anticonvulsants have led to inconsistent findings. Nacetylcysteine (NAC) has shown promise in treatment of obsessive-compulsive and related disorders. The objective of this article is to perform an updated review of NAC in the treatment of grooming disorders. Methods PubMed was searched from inception to October 2017 to identify literature on the use of NAC in the management of trichotillomania, onychophagia, and pathological skin picking. Case reports, case series, and randomized controlled trials were included. Data on study design, dosing regimens, comorbidities, concurrent treatment, and side effects were extracted from the included articles.Results Fifteen articles were included in this review, which consisted of 10 case reports, one case series, and four randomized controlled trials. Dosing of oral NAC ranged from 450 to 2,400 mg per day, and treatment periods lasted from 1 to 8 months. Side effects were uncommon, mild, and usually gastrointestinal in nature, with severe aggression reported in one child.Conclusions While there are multiple reports of the safety and efficacy of NAC in the treatment of grooming disorders, there are currently few randomized controlled trials on this topic, and more research is needed to develop a formal treatment algorithm. While current data should be considered very preliminary, case reports have demonstrated mostly positive results and a lack of significant side effects. A trial of NAC may be a viable option for pathologic grooming disorders, especially in patients who have failed prior psychologic or pharmacologic treatment.

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“…Black dots, coiled hairs, shafts of various lengths, broom fibers, and V-sign (trichoptilosis) are suggestive of TTM. On the other hand, exclamation point hairs, which are suggestive of alopecia areata, are commonly absent in TTM [14,15,16]. Follicular microhemorrhages are a unique dermoscopic sign for the detection of coexisting TTM in cases of alopecia areata [11] and can be extremely useful in doubtful cases.…”

Section: Discussionmentioning

confidence: 99%

The Dermoscopic “Pluck Out Sign” for Beard Trichotillomania

Cutrone

Grimalt

2017

Skin Appendage Disord

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Beard trichotillomania (TTM) is a rather uncommon entity. Hair is not easily plucked from the beard area, as patients need forceps or tweezers to perform their task. The diagnosis of beard TTM can be quite tricky as the location is not the most frequent one. Dermoscopy might in these cases be helpful to achieve the correct diagnosis. In this article, we describe for the first time the “pluck out sign” for beard TTM.

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Trichotillomania: a case report with clinical and dermatoscopic differential diagnosis with alopecia areata

Cited by 13 publications

References 8 publications

Trichoscopy of Dark Scalp

Trichoscopy of Dark Scalp

A review of N‐acetylcysteine in the treatment of grooming disorders

The Dermoscopic “Pluck Out Sign” for Beard Trichotillomania

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