Hair Restoration Blog

Trichotillomania (TTM) [Greek: tricho (hair), till (to pull), and mania], also called trich, is hair loss due to an impulse control disorder distinguished by the repeated urge to pull out hair of scalp, body, eyelashes, eyebrows, facial hair, nose hair or pubic hair.  Trichotillomania may result in noticeable bald spots or hairless patches.

Trichotillomania is more common during the first two decades of life with female predominance; however it could be seen in both sexes and all ages. Trichotillomania may resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual’s teenage years, but may happen at any age. Depression or stress can trigger the trich. Due to social implications, the disorder is often unreported and it is difficult to predict accurately prevalence of Trichotillomania.  It is stated that 2.5 million people in the U.S. may have TTM, with a 1% prevalence rate.

Patients with trichotillomania may live relatively normal lives.  TTM may not be known by the patients and in fact most patients deny any manipulation of the hair.  An additional psychological effect can be low self-esteem, often associated with being rejected by peers and the fear of socializing due to appearance and negative attention they may receive.  Trichotillomania can be effectively treated by habit reversal training along with a variety of psychiatric medications based on the underlying disorder.

I have recently seen a male patient with male patterned baldness in our Los Angeles hair transplant clinic who has previously undergone a hair transplant surgery in another hair transplant clinic about a year before with over 500 grafts on his crown area.  The result of the surgery that should have been completed at the time of our consult was very disappointing both to the patient and to us.  I performed a microscopic evaluation of the scalp in both the frontal and crown area.  I noticed broken hair at both frontal native hair area and crown area, which was evidence of manipulation of the hair.

Patient denied any hair pulling, but had disclosed having experienced a nervous breakdown recently.  However, he did not deny that he had been too conscious about newly implanted hair follicles after his hair transplant that might have forced him pulling most of his transplanted hair grafts.

I recommended a psychological evaluation and treatment of any underlying disorder and we decided to re-evaluate him in a few months after his psychological treatment.  I won’t recommend a hair transplant until he shows no evidence of trichotillomania for a considerable period of time.  I have previously treated a patient who has had hair loss due to trichotillomania at childhood with hair transplant, but was treated completely with no evidence of pulling hair for a long period of time.

Q:

Hi, My name is XX XX and I am from India. My age is 27 years. I am suffering from scarring alopecia from last 10 years. Initially I have 4-5 very small patches, but now they have increased slowly, these patches are very smooth and of red color. I never feel and pain, burn or sever itching on my scalp, but many times I feel sensation under my scalp area and on my face, it is just like something is moving. I have taken lots of treatments Dermatology, homeopathy, ayurveda but none of these worked, may be because I did not continue any one of them more than six month. One or two year back it was kind of arrest but from last one year it again starting and I can see some new small small smooth and red color patches. I am very depressed and don’t know what to do. Please tell me if you can help me in any kind of diagnose or treatment in your research center or by any other way, please help me out. I will be very grateful!!

A:

Scarring alopecia (Cicatricial Alopecia or CC) is a broad term that applied to a diverse group of hair loss disorders.  An inflammatory condition is usually present that causes destruction of the hair follicles.  Biopsy of the scalp is generally needed to establish the diagnosis. Treatment options are different based on the exact microscopic diagnosis.  In many cases the treatment of cicatricial alopecia is difficult and a complete recovery may not be achievable with medical treatments.

Hair transplant has been tried for the treatment of cicatricial alopecia for those who have a healthy donor hair with limited success.  In some cases the process of the disease may flare up and stimulate losing patient’s original hair along with the transplanted ones. I usually obtain a scalp biopsy from patients who have atypical patterns of baldness to role our cicatricial alopecia before planning for a hair restoration surgery in our Los Angeles Hair Restoration Centers.

My recommendation to you is to find a good dermatologist and stick with his or her plan. You need to understand that the treatment of cicatricial alopecia might be long and a complete recovery might not be achievable in many patients.