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PEDIATRICS Vol. 113 No. 5 May 2004, pp. e494-e498

ELECTRONIC ARTICLE

Trichotillomania in Childhood: Case Series and Review

Yong-Kwang Tay, MD^*, Moise L. Levy, MD^, and Denise W. Metry, MD^,

^* Department of Dermatology, Changi General Hospital, Singapore
Departments of Dermatology
Pediatrics, Texas Children's Hospital, Houston, Texas

Trichotillomania is a relatively common cause of childhood alopecia. We report our observations of 10 children with trichotillomania seen over a 2-year period at Texas Children's Hospital. Patient ages ranged from 9 to 14 years (mean: 11.3 years) with an equal gender ratio. The duration of hair-pulling ranged from 1 month to 10 years (median: 4.6 months). The scalp alone was affected in 8 cases, the scalp and eyelashes in 1 case, and the eyelashes alone in 1 case. The frontal scalp and vertex were the most common sites affected. Associated findings included nail-biting in 2 cases, "picking" of the skin in 1 case, and headaches in another case. Noted precipitating factors in 3 patients included "stress" at home and school. Associated psychopathology included major depression in 1 case, attention-deficit/hyperactivity disorder in 1 case, and an "anxious and nervous personality" in 1 case. The most important differential diagnosis to exclude from trichotillomania is alopecia areata, which was seen concomitantly in 1 patient and preceded the onset of hair-pulling by 11 months. Eight patients were referred to a child psychologist for additional management, of which 2 were subsequently treated with antidepressant medication. Trichotillomania is a disorder of multifaceted pathology, and an interdisciplinary approach to management is often helpful. The common prepubertal age of onset provides an important opportunity for the pediatrician to lend support to affected patients and their families.

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Key Words: trichotillomania • hair-pulling

Abbreviations: TTM, trichotillomania • DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition

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Received for publication May 23, 2003; Accepted Dec 16, 2003.

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