Efficacy of N‐acetylcysteine in trichotillomania (<scp>hair‐pulling</scp> disorder), <scp>skin‐picking</scp> disorder and onychophagia (compulsive <scp>nail‐biting</scp>)

Kashetsky, Nadia; Wong, Aaron; Lam, Joseph M.; Wong, Se Mang; Mukovozov, Ilya

doi:10.1111/jdv.18508

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…For example, a recent review included a total of 19 studies (126 patients) and highlighted the use of NAC as a safe and effective treatment for patients with TTM, SPD and onychophagia. 46 This review provided a comprehensive understanding of high-level evidence regarding the pharmacological treatment options for various PPDs. Meanwhile, it is crucial for clinicians to understand the challenges of studying PPDs in RCTs and be familiar with other treatment options identified in other studies.…”

Section: Discussionmentioning

confidence: 99%

“… 45 NAC indirectly elicits an inhibitory effect on synaptic release of glutamate and restoration of extracellular glutamate levels in the nucleus accumbens to improve impulse control. 46 Overall, the specific mechanisms of these pharmacological interventions for PPDs are still unclear.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pharmacological Interventions for Primary Psychodermatologic Disorders: An Evidence Mapping and Appraisal of Randomized Controlled Trials

et al. 2023

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Background The lack of clinical guidelines for the treatment of primary psychodermatologic disorders (PPDs) hinders the delivery of optimal care to patients. The review aimed to identify, appraise, and summarize the currently available evidence about the safety and effectiveness of pharmacological management of PPDs through randomized controlled trials (RCTs). Methods The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRIMSA) statement and the Global Evidence Mapping Initiative guidance were followed. Medline, Embase, PsycInfo, Cochrane and Scopus were searched, and two reviewers independently completed article review, data extraction, and quality assessment. Results Among 2618 unique studies, full texts of 83 were reviewed and 21 RCTs were included. Five PDDs were identified: trichotillomania (n = 12), pathologic skin picking (n = 5), nail biting (n = 2), delusional parasitosis (n = 1), and dermatitis from compulsive hand washing (n = 1). Seven different classes of medications were investigated: SSRIs (i.e., fluoxetine, sertraline, and citalopram), tricyclic antidepressants (i.e., clomipramine and desipramine), antipsychotics (i.e., olanzapine and pimozide), anticonvulsant (i.e., lamotrigine), N-acetylcysteine, inositol, and milk thistle. RCT-derived evidence supports the use of antidepressants in trichotillomania (sertraline and clomipramine), pathologic skin picking (fluoxetine), pathologic nail biting and dermatitis from compulsive hand washing (clomipramine or desipramine); antipsychotics in trichotillomania (olanzapine) and delusional parasitosis (pimozide); N-acetyl cysteine in trichotillomania and skin picking. Conclusion Few pharmacotherapies for primary psychodermatologic disorders are assessed through controlled trials in the literature. This review serves as a roadmap for researchers and clinicians to reach informed decisions with current evidence, and to build on it to establish guidelines in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pharmacological Interventions for Primary Psychodermatologic Disorders: An Evidence Mapping and Appraisal of Randomized Controlled Trials

et al. 2023

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“…Additionally, NAC has been implicated in offering therapeutic benefits for psychiatric disorders, such as depression (Deepmala et al 2015 ). NAC also appears promising in treating trichotillomania, a hair-pulling disorder frequently associated with psychological factors (Kashetsky et al 2023 ). However, in a randomized double-blind clinical trial, it was shown that NAC did not demonstrate a statistically significant difference in the treatment of trichotillomania compared to the placebo group (Bloch et al 2013 ).…”

Section: Underlying Mechanismsmentioning

confidence: 99%

Dissecting hair breakage in alopecia areata: the central role of dysregulated cysteine homeostasis

Xu,

Xie,

Wei

et al. 2024

Amino Acids

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In the initial stages of Alopecia Areata (AA), the predominance of hair breakage or exclamation mark hairs serves as vital indicators of disease activity. These signs are non-invasive and are commonly employed in dermatoscopic examinations. Despite their clinical salience, the underlying etiology precipitating this hair breakage remains largely uncharted territory. Our exhaustive review of the existing literature points to a pivotal role for cysteine—a key amino acid central to hair growth—in these mechanisms. This review will probe and deliberate upon the implications of aberrant cysteine metabolism in the pathogenesis of AA. It will examine the potential intersections of cysteine metabolism with autophagy, ferroptosis, immunity, and psychiatric manifestations associated with AA. Such exploration could illuminate new facets of the disease's pathophysiology, potentially paving the way for innovative therapeutic strategies.

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“…15 Furthermore, a recent metaanalysis investigating the use of NAC for trichotillomania, SPD, and onychophagia (compulsive nail-biting) found a range of NAC regimens-600 mg to 3000 mg daily for 0.5 to 10 monthsto be a safe and effective treatment. 16 However, a 2022 literature…”

Section: Memantinementioning

confidence: 99%

Updates in the Treatment of Body-Focused Repetitive Disorders

Whiting,

Azim,

Friedman

2023

JDD

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Efficacy of N‐acetylcysteine in trichotillomania (hair‐pulling disorder), skin‐picking disorder and onychophagia (compulsive nail‐biting)

Cited by 7 publications

References 12 publications

Pharmacological Interventions for Primary Psychodermatologic Disorders: An Evidence Mapping and Appraisal of Randomized Controlled Trials

Pharmacological Interventions for Primary Psychodermatologic Disorders: An Evidence Mapping and Appraisal of Randomized Controlled Trials

Dissecting hair breakage in alopecia areata: the central role of dysregulated cysteine homeostasis

Updates in the Treatment of Body-Focused Repetitive Disorders

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