Image Based Question – 72073

An otherwise healthy 8-year-old boy presented with a 3-month history of a bald patch on the scalp nonresponsive to empiric treatment with oral and topical antifungals. The child was living with his grandmother while his parents, immigrants in another country, had a conflicting relationship and were divorcing.

Scalp dermoscopy revealed decreased hair density, broken hairs with different shaft lengths, short vellus hairs, black dots, signs of recent hemorrhage, and absence of exclamation mark hairs.
All of the following treatments are useful for this disorder except:

A. SSRI

B. Cognitive Behavioural Therapy

C. Electroconvulsive Therapy

D. Shaving/Clipping Hair close to scalp

Show Answer

Correct Answer » C Explanation

Ans:C. Electroconvulsive Therapy.

Image shows:

(A) Round patch of incomplete alopecia on the vertex demonstrating the “tonsure pattern” or “Friar Tuck sign”. No inflammation or scale was present on examination. (B) Detail of the alopecic area

The patient in question is suffering from Trichotillomania.

Trichotillomania:

• Also known as hair pulling disorder, is an impulse control disorder characterized by a long-term urge that results in the pulling out of one’s hair.

• It occurs more commonly in those with obsessive-compulsive disorder.

• Episodes of pulling may be triggered by anxiety.

• Trichotillomania most commonly begins in childhood.

Treatment modalities:

• Treatment is typical with cognitive behavioral therapy, shaving or clipping hair close to the scalp may be helpful both for stopping the behavior and for educating the parents regarding the nature of the alopecia.

• The primary agents used are selective serotonin reuptake inhibitors (SSRIs).

• The medication clomipramine may also be helpful.