Trichotillomania F63.3

Ripping out one's own head or body hair in the sense of self-stimulation and autoaggression. With younger children, the habit, similar to nail biting or thumb sucking, is more likely to be seen as a "pleasurably experienced calming effect" before falling asleep or watching television.

Lifetime prevalence 0.5-1.5% in boys and up to 3% in girls.

It is also possible as a result of obsessive-compulsive disorders, larvae depression, anxiety disorders, appetence aversion disorders or other psychiatric clinical pictures with impulse disorders.

Trichotillomania is most frequently observed between the ages of 5 and 12.

Predominantly located on the scalp hair, more rarely on the pubic hair. Eyebrows or eyelashes are affected in 25% of cases.

Circumscribed, mostly blurred bald spot (tonsur-like) in the area of the head and/or body hair. More rarely are several alopecia areas. The scalp itself is inconspicuous. The hair follicles are always present in the focus (demarcation to a scarred alopecia). Short hair shafts always remain (typical sign and demarcation to alopecia areata). Their length is determined by the ability to exert sufficient traction. Short hair cannot be detected. Long hairs are pulled out, which are usually twirled for a long time before.

Follicular haemorrhages may be detectable.

Combination with trichophagia is possible. Complication due to swallowing of hair: Trichobezoare= hair balls, which accumulate in the stomach as indigestible balls of wool)

• Trichogram: the telogen rate is reduced.
• Microscopy: Trichoptilosis with green wood fractures and trichorrhexis nodosa-like hairline fractures.

• Difficult. With children, the parents or the social environment must be informed and involved in the therapy.
• Psychological or psychiatric counselling and therapy if necessary.
• With small children, radical short cutting of the head hair can break the hair-pulling tic.

The term "Trichotillomania" is composed of the Greek: Trix = hair, tillein= pulling out, mania= mania.

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