No abstract available.
Trichotillomania*

An 11-year-old girl previously treated for tinea capitis presented a 3-month history of continuous decrease in hair density on the vertex, frontal, and parieto-temporal areas of the scalp. Hair pull test was negative. Trichoscopic findings showed black dots, micro-exclamation point hairs, regrowing vellus hair, and zigzag hairs. Histopathology showed CD3+ peribulbar lymphocytic infiltrates and occasional eosinophils around the anagen hair follicle consistent with a non-scarring alopecia. A diagnosis of diffuse alopecia areata was made. Patient was given methylprednisolone (0.5 mg/kg/day) for 2 weeks and noted marked increase in hair density except on focal areas of the scalp. Patient eventually admitted to occasional hair pulling. Trichoscopy revealed trichoptilosis, V-sign, tulip hairs, and multiple broken hairs of varying length while a second biopsy showed trichomalacia and pigment casts consistent with trichotillomania. In this case, where co-existence of alopecia areata and trichotillomania is considered to be uncommon, trichoscopy proved to be an important tool in differentiating hair disorders with similar presentation. Knowing key features of hair diseases can help elucidate the diagnosis when presented with an atypical case.
Alopecia Areata ; Trichotillomania

Trichotillomania is a neuropsychiatric disorder characterized by repetitive pulling out of one's hair. We present a trichotillomania case study illustrating the effectiveness of habit reversal training, which has recently been found, in western countries, to be a very effective cognitive behavioral treatment. The refractory patient in our study had previously received 1 year of drug treatment and psychiatric consultation for the disorder. We administered 10 habit reversal training sessions, which was followed by an obvious improvement in the patient's trichotillomania symptoms. Our observations indicate that habit reversal training might be effective in the treatment of trichotillomania.
Cognitive Therapy ; Hair ; Humans ; Trichotillomania

Trichotillomania is a disorder of recurrent hair pulling, resulting in the dermatological expression of partial or total hair loss. Trichotillomania has been thought rare for many years, but recently it has been speculated that it is far more common than previously believed. The number of patients is increasing daily. In 1987, a new definition was proposed in the United States, and trichotillomania is now considered to be distinct from mere hair pulling behavior. Worldwide, a debate about the conditions and cures for trichotillomania continues, specifically debates based on the definition adopted in the United States. The author reviews the latest Japanese reports on trichotillomania, comparing key literature from abroad.
Trichotillomania ; Japanese language ; Recent ; United States ; Hair

BACKGROUND: The patients of trichotillomania seem to have received much attention based on patients behavioral psychological aspects, but most of the patients are met in dermatological clinics. Dermatological observation of the lesion dose not seem to not sufficient. OBJECTIVE: The purpose of this study is to exarnine clinical and histopathological characteristics of the lesion of trichotillomania. METHODS: We have observed 28 cases of the trichotillornania and exarnined their cutaneous lesions and histopathological featwres. Histopathological examination with vertical serial sections was done in 21 cases. Because hai folllicles are independent of each other and a usual 5 thickness vertical sect,ion shows only very limited numbers of the hair follicles, authors accomplished sectioning of the biopsied scalp tisue to have 300 serial sections cut and 60 representative sections observed to allow the fullest qiiantitative and qualitative examinations of the follicular pathology of the lesion. RESULTS: The important featuies are as follows. 25 cases(89.2%) were under 18 years old with a slight male predorninance(M:F=1.3:1). Only in 2 cases, psychiatric consultation was made. The degree of involvement was vari ble from less than 5%(6 cases) of the scalp up to 100% involvement of the scalp(3 cases). Thr rnean duration of illness was 12.5 months. The involved hair follicles showed one of the following five roots of hairs they are new hairs with tapered ends, broken short hairs, vellus or intermediate hairs, comedone-like hair bodies or empty follicle orifices. Microscopical observation of thr epilat,ed hairs was done in 16 cases, of which in 13 cases there were no telogen roots of terminal hairs, The histopathological results were as follows : 1. Catagen follicles were increased in 20 cases(95.2%). The actual number of catagen follicles was 1386(37.5%) out of a tota 3695 follicles observed in the total examined slides. 2. Trichornalacia were seen ir 11 cases(52.4%). The actual number of hairs with trichomalacia was 195(10.5%) out of a total 1005 hair canals observed. 3. Pigment clumps of the follicular infundibula were seen in 9 cases(42.9%). The actual number of the pigment-laden infundibula was 148(17.9%) out of a total 826 infundibula observed. 4. Destruction of the hair canal wall were seen in 4 cases(19.0% ). The actual number of destructed hair canal wall was 190(10.2%) out of a total 1863 hair canals observed. Hernorrhage around the follicles was not seen. CONCLUSION: The involved areas of trichotillomania were varied in size up to the whole scalp and showed four different type of hairs. Histopathologically catagen follicles increased in almost all cases with 37.5% of all follicles examined. Trichomalacia, pigmented clumps, and the destruction of hair canals were seen by less frequently.
Adolescent ; Hair ; Hair Follicle ; Humans ; Male ; Pathology ; Scalp ; Trichotillomania*

Trichotillomania is the cllinical syndrome of alopecia resulting from the repetative pulling, plueking and breaking of ones own hair. We report four cases of trichotillomania in 10 year old children. The lesions were limited to the scalp. All of them had psychiatric problems in the school or home according to a psychiatric consultation. The histopathologic examinatiorii revealed a normal number of hair follices, empty hair follicles and no inflammatory reaction. The treatment led to hair growth in three cases but one case did not respond to the treatment.
Alopecia ; Child ; Hair ; Hair Follicle ; Humans ; Scalp ; Trichotillomania*

Trichobezoar usually occurs in patients who have trichotillomania combined with trichophagia. Bezoars can result in serious complications including gastric ulceration, bleeding, perforation and small bowel obstruction when undiagnosed. The three main venues of bezoar removal (chemical dissolution, endoscopic removal and surgical removal) are chosen mainly by the size and composition of the bezoar. Trichobezoars generally require endoscopic or surgical removal. An 8-year-old girl visited our emergency room with recurrent epigastric pain and vomiting. Gastroduodenoscopy showed a 2x10 cm trichobezoar causing pyloric obstruction. During endoscopic removal of trichobezoar, esophageal impaction occurred. The trichobezoar was pushed into the stomach and was removed through surgical gastrostomy under general anesthesia. We report this case as an instructive reference for the proper treatment of trichobezoar in children.
Anesthesia, General ; Bezoars ; Child ; Emergencies ; Gastrostomy ; Hemorrhage ; Humans ; Stomach ; Stomach Ulcer ; Trichotillomania ; Vomiting

A 13-year-old girl presented in our unit with progressive alopecia and a long history of edematous scalp in the occiput. Biopsy specimen of a lesion showed two-type pathologic abnormality consisting of diffuse neurofibroma in the lower portion and trichotillomania in the upper portion. Since the tumor spread diffusely through the lower dermis and subcutaneous fat tissue without destroying surrounding structures, we concluded that the trichotillomania might result from repetitive scratching or other traumatic behavior at the same site of underlying diffuse nerurofibroma. We reported a case of the concomitant occurrence of trichotillomania associated with diffuse neurofibroma.
Adolescent ; Alopecia ; Biopsy ; Dermis ; Female ; Humans ; Neurofibroma* ; Scalp ; Subcutaneous Fat ; Trichotillomania*

A 7 year-old girl had developed multiple bald patches on her scalp for two months and was treated as alopecia areata or trichotillomania at another institution. Biopsy findings of the scalp lesion showed catagen follicles, trichomalacia and pigment clumps in the hair canals with little inflammatory cell infiltrates. Careful history revealed the patient had had "a magic perm" - a hair-straightening perm - one month before the bald patch began to develop. The condition could be called "a magic perm alopecia" as a form of cosmetic traumatic alopecia. The alopecic lesions showed further extension for three to four months. The lesions were beginning to recover five months after they first developed.
Alopecia ; Alopecia Areata ; Biopsy ; Cosmetics ; Hair ; Humans ; Magic ; Polyenes ; Scalp ; Trichotillomania

Trichotillomania (TTM) is a disorder characterized by repetitive hair pulling, frequently from the scalp and/or eyebrows, leading to noticeable hair loss and functional impairment. TTM remains a poorly understood and inadequately treated disorder despite increased recognition of its prevalence. We review available neuroimaging studies conducted in patients with TTM, covering structural and functional neuroimaging in turn. Data from patients' structural and functional neuroimaging results enabled us to identify the neural circuitry involved in the manifestation of hair pulling. Finally, we highlighted the future importance of neuroimaging studies in children and adolescents with TTM.
Adolescent ; Brain ; Child ; Eyebrows ; Functional Neuroimaging ; Hair ; Humans ; Neuroimaging ; Prevalence ; Scalp ; Trichotillomania