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*

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

Steatocystoma multiplex (SM) is an uncommon disorder of the pilosebaceous unit characterized by the development of numerous sebum-containing dermal cysts which rarely involves the scalp. Here, we report a case of a 50-year-old man with multiple cystic nodules and alopecic patches on his scalp. On histopathological examination, the folded cyst was found to be lined by stratified squamous epithelium, while flattened sebaceous gland cells were identified in the cystic wall. Pigment casts were present in the hair papillae and perifollicular regions, suggesting trichotillomania as a possible cause of the observed alopecia. This case appears to represent an unusual clinical manifestation of SM.
Alopecia ; Epithelium ; Hair ; Humans ; Middle Aged ; Scalp ; Sebaceous Glands ; Steatocystoma Multiplex ; Trichotillomania

BACKGROUND: Conventional vertical sections of scalp biopsy specimens are often inadequate for the diagnosis of alopecia. Alternatively, a better approach can often be provided with the use of transverse sections continues, which is readily available and continues to grow in popularity. OBJECTIVE: The purpose of this study was to compare the histopathologic findings of transverse and vertical sections of scalp biopsy specimens in various types of alopecia. METHODS:A total of 27 scalp biopsy specimens obtained during the past 16 months for the evaluation of alopecia was processed for either transverse or vertical section, or for both. With these sections a quantitative morphologic study was done by counting a variety of follicular structures, and any specific histopathologic changes were recorded. RESULTS: Diagnostic features that were better seen in vertical sections included quantitative morphologic changes of a variety of follicular structures such as total number of follicles, catagen and telogen hairs, vellus hairs and follicular stele, as were anagen-telogen ratios and terminal-vellus ratios. Other histopathologic findings that were better demonstrated in transverse sections included peribulbar inflammatory infiltrate for alopecia areata, miniaturization for androgenetic alopecia, trichomalacia and pigment cast for trichotillomania, and fat atrophy for pressure alopecia. In some cases, especially for scarring alopecia, vertical sections also allowed for useful adjunctive diagnostic information such as follicular destruction, dermal fibrosis and sclerosis, and interface change. CONCLUSION: Transverse sections of scalp biopsy specimens provided many useful information in histopathologic diagnosis of alopecia. But, in some cases of scarring alopecia, vertical sections provided more diagnostic findings. To overcome the diagnostic limitation of transverse sections, therefore, observing both transverse and vertical sections at a time could be an alternative way of enhancing diagnostic yield of alopecia.
Alopecia Areata ; Alopecia* ; Atrophy ; Biopsy ; Cicatrix ; Diagnosis ; Fibrosis ; Hair ; Miniaturization ; Scalp ; Sclerosis ; Trichotillomania

BACKGROUND: Conventional vertical sections of scalp biopsy specimens are often inadequate for the diagnosis of alopecia. Alternatively, a better approach can often be provided with the use of transverse sections continues, which is readily available and continues to grow in popularity. OBJECTIVE: The purpose of this study was to compare the histopathologic findings of transverse and vertical sections of scalp biopsy specimens in various types of alopecia. METHODS:A total of 27 scalp biopsy specimens obtained during the past 16 months for the evaluation of alopecia was processed for either transverse or vertical section, or for both. With these sections a quantitative morphologic study was done by counting a variety of follicular structures, and any specific histopathologic changes were recorded. RESULTS: Diagnostic features that were better seen in vertical sections included quantitative morphologic changes of a variety of follicular structures such as total number of follicles, catagen and telogen hairs, vellus hairs and follicular stele, as were anagen-telogen ratios and terminal-vellus ratios. Other histopathologic findings that were better demonstrated in transverse sections included peribulbar inflammatory infiltrate for alopecia areata, miniaturization for androgenetic alopecia, trichomalacia and pigment cast for trichotillomania, and fat atrophy for pressure alopecia. In some cases, especially for scarring alopecia, vertical sections also allowed for useful adjunctive diagnostic information such as follicular destruction, dermal fibrosis and sclerosis, and interface change. CONCLUSION: Transverse sections of scalp biopsy specimens provided many useful information in histopathologic diagnosis of alopecia. But, in some cases of scarring alopecia, vertical sections provided more diagnostic findings. To overcome the diagnostic limitation of transverse sections, therefore, observing both transverse and vertical sections at a time could be an alternative way of enhancing diagnostic yield of alopecia.
Alopecia Areata ; Alopecia* ; Atrophy ; Biopsy ; Cicatrix ; Diagnosis ; Fibrosis ; Hair ; Miniaturization ; Scalp ; Sclerosis ; Trichotillomania