Trichoteiromania: Good Response to Treatment with N-Acetylcysteine

Abstract

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.

Monotonous Broom Hairs: A Feature of Trichoteiromania

“…João/Cunha/Pessoa e Costa/Lencastre Skin Appendage Disord 2020;6:168-170 170 DOI: 10.1159/000506602 trichotillomania (hair plucking) [4], lichen simplex chronicus changes found herein support the diagnosis, illustrating the itch-rub/scratch-itch cycle [1,2].…”

“…These are 1-2 cm long and macroscopically white-tipped, seen under trichoscopy as longitudinally split hair shafts (brush-like ends or broom hairs), resembling trichoptilosis. Broom hairs are the reflection of continuous frictional damage that gradually erodes the less adherent distal cuticular cell margins [1,3], and they have recently been considered to be a trichoscopic feature highly suggestive of trichoteiromania [2]. Although they can also be less frequently seen in…”

“…The latter include patient education and eventually psychotherapy [3]. Oral N-acetylcysteine has been successfully employed to control the urge to scratch in one case, requiring further studies [2].…”

“…Trichoteiromania is a rare type of artificial hair loss in which breaking of the hair shafts results from repetitive rubbing of the scalp [1]. Excessive scratching may also cause lichen simplex chronicus [2]. Trichoscopy is a useful tool for the diagnosis, with broom hairs representing a common feature [3].…”

Trichoteiromania in adults

“…В литературе описаны единичные случаи трихотейромании, которая приводит к нерубцовой потере волос в результате их растирания и характеризуется расщеплением и повреждением стержня [1][2][3][4][5]. По мнению J.M.…”