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Editor,—Trichotillomania is the inability to resist the urge to pull out body hair. We present a case of this rare condition.
A 12 year old boy was referred to the eye clinic with complaints of dropping of eyelashes of both upper eyelids. He was seen by his optician before the referral. Lid hygiene, propamidine isethionate eye ointment 0.15% (Brolene), and sodium cromoglycate eye drops 2% (Opticrom) were tried but with no benefit. The mother reports that his eyelashes grew while they were abroad on a holiday for a fortnight and then fell off once they returned from their holiday!
When seen in the eye clinic his visual acuities were 6/5 bilaterally. He had no significant ocular history, was generally fit and well, and was taking no regular medications. His parents did not express any concerns regarding his health or his behaviour. On examination, the eyelashes of both upper eyelids were scarce centrally. The few lashes, which were seen, had pointed and not cut ends. On either side the lashes were normal. There was no evidence of inflammation or disease of the lid margins and the rest of the ocular examination was normal. There was no evidence of loss of eyebrow or scalp hair. He is being considered for psychiatric evaluation.
Trichotillomania is characterised by an irresistible urge to pull one's hair. Any body hair may be targeted. Scalp and eyelashes are most commonly affected. Onset is generally in childhood or adolescence, and a chronic course is typical. Depression and anxiety frequently accompany this disorder. An increased incidence of co-morbid obsessive-compulsive disorder (OCD) has been noted.1 The estimated lifetime prevalence is 1.5% for male and 3.4% for female college students.2 In very young patients, a more equal sex ratio is observed. On the whole, women show 5–10 times higher prevalence rates than men.2 The majority of the sufferers disguise their hair loss very well. Because of the secrecy and shame about their behaviour, many remain silent sufferers and treatment is often delayed. It is a chronic mental illness that imposes severe limitations on the patient's social, emotional, and occupational adjustment. The pathophysiology of trichotillomania is not well understood. Treatment options include: medications such as serotonin reuptake inhibitors with or without haloperidol,1 paroxetine,3clomipramine,4 pimozide,2 risperidone in serotonin reuptake inhibitor refractory trichotillomania,5venlafaxine6; behaviour therapy habit reversal training1 2 4 and hypnotherapy.1
Trichotillomania has been infrequently reported in the ophthalmic literature. Management can be difficult. Many of these patients are aware of their behaviour, but are unable to curtail it. Others may conceal or deny their habit. Psychiatric counselling may be of benefit if patients are willing to undergo it.