Pediatric trichotillomania: Review of management

Abstract

Trichotillomania can present in childhood, with many families seeking initial evaluation by a dermatologist for hair loss. Prompt and accurate diagnosis by dermatologists is crucial, as children can suffer from academic or social impairments as well as mental health sequelae. Children are especially vulnerable to lasting psychological distress from appearance‐related bullying. This article reviews the psychosocial impacts of pediatric trichotillomania and the current interventions studied in this population. Included are studies evaluating behavioral therapies as well as pharmacologic options. This review highlights the importance of early and appropriate identification, intervention, and the need for more treatment studies in the pediatric population.

Trichotillomania in Children and the Different Approaches between Dermatological and Behavioral Health Professionals at an Urban Tertiary Care Center

“…Previous text has suggested that patients initially pre­sent for hair loss at dermatology [9]. However, most of our patients were treated by behavioral health at initial presentation (63.5%).…”

“…In fact, 12 patients treated in a psychodermatology service for various skin disorders noted improvement in their conditions [20]. Since habit reversal therapy is the most effective therapeutic option to date, dermatologists are recommended to create partnerships with experienced community mental health providers [9].…”

“…Psychological comorbidities commonly include mood disorders, anxiety disorders, substance use disorders, eating disorders, and disruptive behavior in youth [8]. There is no definitive cure for TTM in children, with treatment options varying from patient education and behavioral therapy to over-the-counter supplements and medications such as N -acetylcysteine (NAC) or topical therapies like steroids with variable potencies [9].…”

“…There has been limited text in pediatric TTM until recently. Studies have claimed that patients initially present at dermatology due to the associated hair loss [9]. Other studies have found patients seek help from a mental health clinician as TTM is considered a psychiatric diagnosis [10].…”

Trichotillomania Incognito: Two Case Reports and Literature Review

“…Diagnosing scalp trichotillomania in pediatric patients is often tough as other disorders have similar clinical presentation, mainly alopecia areata and tinea capitis [1, 10]. Two types of hairpulling have been described for trichotillomania: automatic and focused [3, 5]. Automatic occurs outside of one’s own awareness, while focused pulling happens in awareness and in response to negative emotional states, such as stress, sadness, anger, or anxiety [3, 5, 8].…”