N-acetylcysteine in the treatment of trichotillomania

Rodrigues-Barata, Ana Rita; Tosti, Antonella; Rodríguez‐Pichardo, A.; Camacho‐Martínez, F.

doi:10.4103/0974-7753.100090

Cited by 55 publications

(45 citation statements)

References 6 publications

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“…Grant et al [7] evaluated the efficacy of NAC from 1,200 to 2,400 mg/day in a double-blind, placebo-controlled study on 50 adult patients with trichotillomania, and they observed a significant reduction of hair pulling compared to placebo. Similarly, there are several case reports of patients with trichotillomania successfully treated with oral NAC [8-12]. The mechanism of action of NAC in the treatment of OCD is possibly due to its action on the glutamate system: glutamatergic hyperactivity leading to excitotoxicity and oxidative stress has been implicated in the pathogenesis of OCD [13].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Trichoteiromania: Good Response to Treatment with N-Acetylcysteine

Salas‐Callo¹,

Pirmez²

2019

Skin Appendage Disord

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Lichen simplex chronicus on the scalp, also known as trichoteiromania, can be difficult to manage, as the therapeutic options are limited to topical or intralesional glucocorticoids. We describe a patient with trichoteiromania, presenting three lichenified pruriginous plaques on different regions of the scalp, associated with fracture and loss of hair shafts. Prior treatment with potent topical glucocorticoids was ineffective. However, treatment with oral N-acetylcysteine (NAC) 1,200 mg/day resulted in complete hair regrowth within 16 weeks. NAC is a safe drug with a good tolerance profile that could be a therapeutic option for patients with trichoteiromania. The potential of NAC has not been completely elucidated, thus more studies will be necessary to confirm its efficacy in the long term for some psychodermatological conditions.

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Section: Discussion/conclusionmentioning

confidence: 99%

Trichoteiromania: Good Response to Treatment with N-Acetylcysteine

Salas‐Callo¹,

Pirmez²

2019

Skin Appendage Disord

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“…Indeed, the GSH-precursor, NAC, has demonstrated preliminary efficacy in the treatment of OCD (65–67) and other OCRD such as trichotillomania (68–70), excoriation disorder (69, 71) and nail biting (69, 72). While others have theorized that the beneficial effects of NAC in OCRD result from its ability to modulate glutamatergic neurotransmission (68), we propose that NAC’s capacity to increase GSH synthesis may also play a significant role.…”

Section: Discussionmentioning

confidence: 99%

Lower Posterior Cingulate Cortex Glutathione Levels in Obsessive-Compulsive Disorder

Brennan

Jensen

Perriello

et al. 2016

Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

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Background Several lines of evidence support the hypothesis that lower cerebral levels of glutathione (GSH), associated with increased oxidative stress, may contribute to obsessive-compulsive disorder (OCD). However, no studies to date have investigated brain GSH levels in individuals with OCD. Methods Twenty-nine individuals with OCD and 25 age-, sex-, and race-matched comparison individuals without OCD underwent single voxel 2D J-resolved proton magnetic resonance spectroscopy (MRS) to examine GSH levels in the posterior cingulate cortex (PCC). MRS data were analyzed using LCModel and a simulated basis set. Group metabolite differences referenced to total creatine (Cr), as well as relationships between metabolite ratios and symptom severity as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), were analyzed using linear regression with adjustment for age, sex, and race. Results One OCD participant failed to produce usable PCC MRS data. We found significantly lower PCC GSH/Cr in OCD participants compared with non-OCD participants (β = −0.027 [95% CI: −0.049 to −5.9 × 10−3]; P = 0.014). PCC GSH/Cr was not significantly associated with total Y-BOCS score in the OCD group (β = 5.7 × 10−4 [95% CI: −4.8 × 10−3 to 5.9 × 10−3]; P = 0.83). Conclusions Lower PCC GSH/Cr may be indicative of increased oxidative stress secondary to hypermetabolism in this brain region in OCD. Future MRS studies are warranted to investigate GSH levels in other brain regions that comprise the cortico-striato-thalamo-cortical circuit thought to be abnormal in OCD.

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“…Third, preclinical data and research in mice and in adults with intellectual disabilities show that naltrexone, an opioid antagonist, can help in reducing excessive grooming behaviors and self-injurious behaviors [12, 35]. Finally, there is significant evidence that N-acetylcysteine, which modulates glutamate, the main neurotransmitter in the fronto-striato-thalamic-cortical circuit, may have efficacy in treating trichotillomania [36–42]. …”

Section: Discussionmentioning

confidence: 99%

Trichotillomania as a Manifestation of Dementia

Paholpak

Mendez

2016

Case Reports in Psychiatry

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Pathological hair-pulling or trichotillomania, which is commonly associated with anxiety and depression, obsessive-compulsive disorder, and neurodevelopmental disorders, has been rarely associated with dementing illnesses. Investigators have not clarified the neural correlates and treatment of trichotillomania in dementia. We report a patient who developed an early-onset cognitive decline with genetic, cerebrospinal fluid biomarker and structural and functional neuroimaging studies consistent with Alzheimer's disease. Eight years into her disease, she developed severe, repetitive hair-pulling behavior leading to marked hair loss, along with other repetitive and “frontal” behaviors. Selective serotonin reuptake inhibitors (SSRIs) were ineffective in controlling her hair-pulling behavior, which subsequently responded to quetiapine 150 mg/day. This patient and a review of the literature suggest that trichotillomania may be a compulsive-related symptom in dementias of different etiologies as they involve frontal areas and release primitive grooming behavior from frontostriatal dysfunction. Dopamine blockade, rather than SSRIs, may be effective in managing trichotillomania in dementia.

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N-acetylcysteine in the treatment of trichotillomania

Cited by 55 publications

References 6 publications

Trichoteiromania: Good Response to Treatment with N-Acetylcysteine

Trichoteiromania: Good Response to Treatment with N-Acetylcysteine

Lower Posterior Cingulate Cortex Glutathione Levels in Obsessive-Compulsive Disorder

Trichotillomania as a Manifestation of Dementia

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