BACKGROUND: Trichotillomania is a self-induced, primary psychiatric disorder. Dermatologists, however, should understand the nature of the disorder, because it is a type of alopecia which is more likely to be examined first by dermatologists, and early treatment yields a better prognosis. A long-term observation of the clinical course of trichotillomania patients is lacking in Korean dermatological literature. OBJECTIVE: We attempted to appreciate the long-term clinical course, the sociofamilial situation and other associated disorders, as well as the trichological findings of the disease. METHOD: Sixty nine trichotillomania patients, diagnosed from May 1983 to July 2003, were reviewed via medical records, out-patient clinic follow-up and by telephone survey. RESULTS: 1. The average age of onset of the lesion was 10.1 years old, and the average age of the first examination was at 11.1 years. 89.1% of the patients were found to be adolescent or younger. Sex prevalence showed female predominance in adulthood, similar distributions in adolescence and late childhood, but more males in early childhood. 2. The duration between onset of the lesion and first examination were several months in early childhood, one to two years in adolescence and four to eight years in adults. 3. The sites most frequently affected were the parietal (78.3%) and the frontal scalp (50.7%). Thirty eight patients (55.1%) showed a single lesion, and 18 patients (26.1%) showed severe involvement with more than 25% of the scalp affected. 4. The broken shafts of terminal anagen hairs were seen in most patients (89.9%). Fifty nine patients (85.5%) had hair thinning patches composed of varied hairs such as broken shafts, new emerging tapered hairs, vellus and intermediate hairs, comedone-like black dots and empty follicles. In the remaining 10 patients (14.5%), one type of the pre-mentioned hair states was dominantly seen. 5. In late childhood and older cases, about 1/3 of the patients admitted to repetitive hair touching, and family members confirmed this behavior in 2/3 of the cases. 6. Of the patients evaluated in the study, only 13% had suffered a stressful situation, 13% a broken home or 6% from maladjustment. The rate of dual income families among the patients was 44%, similar to the rate within the general population of Korea. 7. Forty seven patients were assessed for an average of 6 years and 7 months. Thirty two patients (68.1%) were diagnosed as free from trichotillomania, and 15 patients (31.9%) showed continuing lesions. By age distinction, the persistence rates were 75% in adult patients, 29% in late childhood and adolescent patients, and 22% in early childhood patients. By gender difference, 78.3% (18/23) of males and 58.3% (14/24) of females were free from alopecia. CONCLUSION: Dermatological findings, patients cognition of their behavior, and clinical analysis of 69 cases of trichotillomania were made with the results of 6 years and 7 months of follow-up observations. The clinical analysis included not only dermatological findings, but also patients' cognition and other factors which might influence the patients' habitual behavior.
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