Trichotillomania: An Impulsion beyond Hair Pulling

Abstract

Introduction: Trichotillomania is a psycho-dermatologic disorder that has been identified as a common morbidity in children and adolescents having a positive correlation with depression and Obsessive Compulsive Disorder (OCD). Very few cases have been reported in the 20-30 age groups, therefore, we intend on reporting this case. Case Presentation: We report a case of a 26-year-old male patient who presented in Psychiatry Outpatient Department and was diagnosed with Trichotillomania (TTM). The patient’s family observed him of being involved in a puzzling behavior. They found him pulling hair from different parts of his head. Inspection of his face revealed patchy hair loss from his eyebrows and moustache. Dermatologic examination of the scalp revealed irregular bald patches. Trichoscopy of the alopecic patch further highlighted random hair lengths with no exclamation mark hairs. The patient was started on Trifluperazine, Trihexyphenidyl, and Clonazepam along with sessions of Behavioral therapy and was advised regular follow ups. Conclusion: The diagnosis of our patient was established upon the history, clinical and dermatologic evaluation, and eventual elimination of the possible differential diagnosis. Although rare, this disorder can leave a significant burden on patient’s mental status giving rise to behavioral abnormalities.