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

Abstract

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.

Pediatric trichotillomania: Review of management

“…Given reported success among adults with TTM and patients with other body‐focused repetitive behaviors (excoriation disorder, nail biting), the use of NAC should be explored by additional randomized controlled trials in the pediatric population to better inform its role in treatment . NAC’s low‐risk side‐effect profile and demonstrated case success make it a consideration for childhood TTM refractory to behavioral therapy …”

“…25,26 NAC's low-risk side-effect profile and demonstrated case success make it a consideration for childhood TTM refractory to behavioral therapy. 27 Other investigated pharmacologic options in the adult population include serotonin reuptake inhibitors (SSRIs), antipsychotics, dronabinol, and tricyclic antidepressants. However, most data on these options are from case reports or limited trials; thus, there is inconsistent evidence to inform pharmacologic treatment, especially in children.…”

Protonation Equilibria of N-Acetylcysteine

“… 12 Meyer stated that consuming Nac daily in safe amounts may prevent degenerative disease, reduce the attacks of chronic pulmonary disease, and improve insulin sensitivity. 13 Many studies summarizing the role of Nac in therapy of distal intestinal obstruction syndrome, 14 psychodermatological disorders, 15 grooming disorders, 16 Helicobacter pylori eradication, 17 neurodegenerative diseases, 18 addictions, 19 schizophrenia, 20 idiopathic pulmonary fibrosis, 21 and cardiovascular disorders 22 have been published in the last eight years.…”

Pubic trichotillomania in a beauty pageant contestant

“…N-acetylcysteine is a glutamate-modulating agent which has shown positive results (1200–2400 mg/day) with only mild side effects. [ 3 ] Other options include clomipramine (tricyclic antidepressant) and olanzapine (antipsychotic). There is no high-quality evidence to support the use of fluoxetine, lamotrigine, inositol, or naltrexone.…”