Vestnik dermatologii i venerologiiVestnik dermatologii i venerologiiВестник дерматологии и венерологии0042-46092313-6294Rossijskoe Obschestvo Dermatovenerologov i Kosmetologov112710.25208/vdv1127CLINICAL CASE REPORTSНАБЛЮДЕНИЕ ИЗ ПРАКТИКИResearch ArticleTrichoteiromania in adultsТрихотейромания у взрослыхMareevaAnastasia N.МарееваАнастасия Николаевна
Russian Federation

Cand. Sci. (Med.), Dermatovenereologist, Consultative Diagnostic Centre

к.м.н., врач-дерматовенеролог консультативно-диагностического центра

nastasya_66@mail.ruPichuginaIrina M.ПичугинаИрина Михайловна
Russian Federation

Cand. Sci. (Med.), Dermatovenereologist, Consultative Diagnostic Centre, State Research Center of Dermatovenereology and Cosmetology

к.м.н., врач-терапевт, гастроэнтеролог, психиатр, психотерапевт, доцент кафедры внутренних болезней

dr.pichugina@gmail.comState Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian FederationФГБУ «Государственный научный центр дерматовенерологии и косметологии» Минздрава РоссииKaluga State University named after K.E. TsiolkovskyФГБУ ВО «Калужский государственный университет им. К.Э. Циолковского»0208202096244502004202014052020Copyright ©; 2020, Mareeva A.N., Pichugina I.M.Copyright ©; 2020, Мареева А.Н., Пичугина И.М.2020Mareeva A.N., Pichugina I.M.Мареева А.Н., Пичугина И.М.https://creativecommons.org/licenses/by/4.0https://vestnikdv.ru/jour/article/view/1127

This paper describes two clinical cases of a rare auto-destructive hair pathology — trichoteiromania. In the literature a few cases of trichoteiromania are described, it leads to non-cicatricial hair loss as a result of their rubbing and is characterized by splitting and damaging of the hair shaft.

The clinical picture features, trichoscopic signs of the disease are presented: foci of baldness in the scalp, hair shafts not more than 1.5 cm long, curved, scaling as a result of scratching the skin. Trichoscopic features: broken hair up to 1,5 сm length, splitting of the distal end of the hair shaft (trichoptilosis), scaling.

The data on the differential diagnosis of the disease with other hair pathologies, the possible symptomatic, psychotherapeutic, psychopharmacological treatment of trichoiteromania are presented.

These clinical cases are of interest in connection with rare descriptions in the literature, the importance of trichoscopy in the differential diagnosis of alopecia, the possibility of interaction between a dermatologist and a psychiatrist, a psychotherapist are indicated.

Приведены собственные клинические наблюдения редкой аутодеструктивной патологии волос — трихотейромании. В литературе описаны единичные случаи трихотейромании, которая приводит к нерубцовой потере волос в результате их растирания и характеризуется расщеплением и повреждением стержня.

Представлены особенности клинической картины, трихоскопические признаки заболевания: очаги облысения в области волосистой части головы, в очагах стержни волос длиной не более 1,5 см, изогнуты, шелушение в области поредения в результате царапания кожи, при трихоскопии — стержни расщеплены на кончиках по типу «метелки» (трихоптилоз).

Приведены данные о дифференциальной диагностике заболевания с другими патологиями волос, возможном симптоматическом, психотерапевтическом, психофармакологическом лечении трихойтеромании.

Данные клинические случаи представляют интерес в связи с редкими описаниями в литературе, обозначена важность трихоскопии в дифференциальной диагностике алопеций, возможности взаимодействия врача-дерматолога и психиатра, психотерапевта.

trichoteiromaniatrichotillomaniatrichoscopyalopeciahair lossтрихотейроманиятрихотилломаниятрихоскопияалопециявыпадение волосPereira J.M. Compulsive trichoses. An Bras Dermatol. 2004; 79 (5): 609—18.Freyschmidt-Paul P., Hoffmann R., Happle R. Trichoteiromania.Eur J Dermatol. 2001; 11: 369—71.Salas-Callo C.I., Pirmez R. Trichoteiromania: Good Response to Treatment with N-Acetylcysteine. Skin Appendage Disord. 2019 Jun; 5 (4): 242—245. doi: 10.1159/000497167. Epub 2019 Mar 8.Shumway N.K., Cole E., Fernandez K.H. Neurocutaneous diseases: neurocutaneous dysesthesias. J Am Acad Dermatol 2016; 74: 215—228; quiz 229—230.Runne U. Chronische Pseudo-alopezie durch ständiges. Kratzen (Kratz-Pseudoalopezie). Z Hautkr. 2000; 75: 444-5.Arnold L.M., Auchenbach M.B., McElrou S.L. Psychogenic excoriation. Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs. 2001; 15: 35—9.Touraine L.M., Auchenbach M.B., McElrou S.L. Psychogenic excoriation. Clinical features, proposed diagnostic criteria, epidemiology and aproaches to treatment. CNS Drugs. 2001; 15: 351—9.Banky J.P., Sheridan A.T., Dawber R.P. Weathering of hair in trichoteiromania. Australas J Dermatol. 2004 Aug; 45 (3): 186—8.Mubki T., Rudnicka L., Olszewska M. et al. Evaluation and diagnosis of the hair loss patient: part II — trichoscopy and laboratory evaluations. J Am Acad Dermatol 2014; 71: 431—441.Lee D.Y., Lee J. H., Yang J. M. et al. The use of dermoscopy for the diagnosis of trichotillomania. J Eur Acad Dermatol Venereol 2009; 23: 731—732.Rakowska A., Slowinska M., Olszewska M. et al. New trichoscopy findings in trichotillomania: flame hairs, V-sign, hook hairs, hair powder, tulip hairs. Acta Derm Venereol 2014; 94: 303—306.Orgaz-Molina J., Husein-ElAhmed H., Soriano-Hernandez M.I. et al. Trichotemnomania: hair loss mediated by a compulsive habit not admitted by patients. Acta Derm Venereol 2012; 92: 183—184.Bourezane Y., Bourezane Y.Analysis of trichoscopic signs observed in 24 patients presenting tinea capitis: hypotheses based on physiopathology and proposed new classification. Ann Dermatol Venereol 2017; 144: 490—496.Rudnicka L., Olszewska M., Rakowska A. et al. Trichorrhexisnodosa; Atlas of Trichoscopy — Dermoscopy in Hair and Scalp Disease. London, Springer, 2012. Pp. 159—166.Adil M., Amin S.S., Mohtashim M. N-acetylcysteine in dermatology. Indian J Dermatol Venereol Leprol. 2018 Nov-Dec; 84 (6): 652—9.Bezerra A.P., Machado M.O., Maes M. et al. Trichotillomania-psychopathological correlates and associations with health-related quality of life in a large sample. CNS Spectr. 2020 Apr 8: 1—8. doi: 10.1017/S109285292000111X.Jones G., Keuthen N., Greenberg E. Assessment and Treatment of Trichotillomania (Hair Pulling Disorder) and Excoriation (Skin Picking) Disorder. Clin Dermatol. Nov-Dec2018;36(6):728-736.doi: 10.1016/j.clindermatol.2018.08.008. Epub 2018 Sep 19. PMID: 30446196 DOI: 10.1016/j.clindermatol.2018.08.008.Rothbart R., Stein D. Pharmacotherapy of Trichotillomania (Hair Pulling Disorder): An Updated Systematic Review. Expert Opin Pharmacother. 2014 Dec; 15 (18): 2709—19. doi: 10.1517/14656566.2014.972936.Solmi M., Tamiello G., Manuli G. Lamotrigine Induces Hair Loss in a Patient With Treatment-Resistant Major Depressive Disorder. Am J Ther. Sep/Oct 2017; 24 (5): e611-e612. doi: 10.1097/MJT.0000000000000586. PMID: 28346304 DOI: 10.1097/MJT.0000000000000586.Adil M., Amin S.S., Mohtashim M. N-acetylcysteine in dermatology. Indian J Dermatol Venereol Leprol. 2018 Nov-Dec; 84 (6): 652—9.Grant J.E., Odlaug B.L., Kim S.W. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebocontrolled study. Arch Gen Psychiatry. 2009 Jul; 66 (7): 756—63.Rodrigues-Barata A.R., Tosti A., Rodriguez-Pichardo A. et al. N-acetylcysteine in the treatment of trichotillomania. Int J Trichology. 2012 Jul; 4 (3): 176—8.Taylor M., Bhagwandas K. N-acetylcysteine in trichotillomania: a panacea for compulsive skin disorders? Br J Dermatol. 2014 Nov; 171 (5): 1253—5.França K., Lotti T. N-acetylcysteine in the treatment of trichotillomania. Dermatol Ther (Heidelb). 2017 May; 30 (3): 1—1.Özcan D., Seçkin D. N-Acetylcysteine in the treatment of trichotillomania: remarkable results in two patients. J Eur Acad Dermatol Venereol. 2016 Sep; 30 (9): 1606–8.Barroso L.A., Sternberg F., Souza M.N. et al. Trichotillomania: a good response to treatment with N-acetylcysteine. An Bras Dermatol. 2017 Jul-Aug; 92 (4): 537—9.Couto J.P., Moreira R. Oral N-acetylcysteine in the treatment of obsessive-compulsive disorder: a systematic review of the clinical evidence. Prog Neuropsychopharmacol Biol Psychiatry. 2018 Aug 30; 86: 245—54.