There is a lack of consensus regarding the most appropriate treatment for trichotillomania. In a recent study, findings highlights the urgent need for more research, especially in the form of clinical trials for possible treatments.
Trichotillomania may manifest itself with skin reactions (erythema, urticarial rash, blisters), hair loss and excessive hair pulling. The condition has also been associated with anxiety. There is no set course for treatment. The condition can lead a person to severe psychiatric morbidity, family conflict and social isolation. Data from a recent study, 30% of male patients with trichotillomania showed psychotic features. In some cases, trichotillomania is an integral part of a psychotic disorder and in such an case, psychiatric treatment of the disorder is required.
It is likely that TTM is a non-removable genetic disorder that cannot be cured. However, it can be controlled. Behavioral treatments such as behavioral therapy can help patients overcome any negative emotional experiences caused by TTM, and may help patients overcome feelings of anxiety that often occur as a result of learning that their disorder has not been cured The goal of both therapeutic and behavioral treatment programs should be [to help patients develop the skills necessary to cope with their TTM] (http://wwwnhs.webmd.com/tics/trichotillomania/trichotillomania.htm.).
The specific cause [or causes] of trichotillomania is not known. It is suggested that it is one of several hair removal disorders linked to a psychiatric disorder, due to shared underlying neural activation. However, the exact neuropathology and neurophysiological deficits of trichotillomania are not yet known. Theories involve the central dopaminergic system, hyperactivity of the norepinephrine system, and excessive stimulation by stimuli. Further research should be conducted examining the underlying neural processes in the brain.
There is not much research on the prevalence of trichotillomania. To the authors' knowledge, the reported data suggest that it is more common than it had been thought. Given the wide range reported by different investigations, further investigation and research are needed.
The prevalence of hair removal disorders is higher than that of cosmetic surgery disorders in women. There is still large variation between countries that is not evident in other medical disorders and this variation may reflect the way in which hair disorders are conceptualised.
Since the onset of trichotillomania is usually gradual, these results suggest that genetic susceptibility to stress might be a possible pathogenetic factor of this symptom.
Memantine was shown to be well tolerated in this population, with low rates of most side effects. The most common side effect of memantine was dizziness and in a minority of cases, there was an increase in suicidal ideation and attempts. At least two cases of suicidal ideation in patients on memantine are reported every year; this is a small absolute risk to patients taking memantine, and the number of cases required to inform clinical practice appears small. These risk factors should, however, be considered by clinicians when prescribing memantine in this setting.
Although this article focuses on memantine for therapeutic use, this drug has now also been approved for the treatment of trichotillomania. The latest therapeutic study on memantine (150-mg) showed that patients received the highest dose of memantine (300-mg) had the lowest rate of side-effects and the best efficacy. Side-effects include dizziness, drowsiness, nausea, and fatigue. The only side-effect that affected more than two-thirds of the patients was headache.
These preliminary findings suggest that memantine may be useful in the management of trichotillomania, though an extended trial with a more rigorous design is warranted.
Memantine may be useful in treating trichotillomania, but clinicians need to be careful when prescribing memantine for this indication. At very low doses (<16 mg daily at bedtime) in elderly outpatients with a history of alcoholism, patients will sometimes experience agitation, dizziness, drowsiness, headache, or confusion. It's not known if these are side effects of memantine, though some of these experiences were found while patients were taking anticholinergic or anxiolytic medication. Also, caution should be used when administering memantine to pregnant women, as use during pregnancy with any antidepressant, or any time, may harm a developing fetus.