Hair Restoration Blog

Trichotillomania is a type of patchy hair loss which results from the compulsive pulling out or scratching of hair shafts.   The cause of this compulsive behavior is not completely understood.  Trichotillomania is not an uncommon condition and it can be seen in both sexes as well as different ethnic backgrounds.  Its lifetime incidence is about 0.6% and may be as high as 1.5% in men or 3.4% in women.

People with trichotillomania may initially be seen by a dermatologists or hair transplant surgeons without its sufferer being aware of their pulling hair habits.  Trichotillomania generally shows its first signs before the age of seventeen.  Circular balding patches are the initial signs that are typically seen almost anywhere that hair grows.  The balding patches are uneven and incomplete, unlike other patchy baldness conditions such as Alopecia Areata in which hair loss is almost complete in the balding patch.

Trichotillomania: Microscopic evaluation of lesions. Left: Hair shafts in different length and growth phases. Right: Hair loss and scalp skin inflammation due to scratching the skin by patient. (Parsa Mohebi, MD)

Microscopic examination of the balding patchs show broken hair and fine hair in different stages of growth.  Balding patchs of trichotillomania can most-likely be found on the scalp, eyebrows and eyelashes, but almost any area of skin has the possiblity of being involved.

Denying hair pulling is very common and in most patients, the doctor or one of the family members notices their habits first. Other self injury behaviors may be accompanied in patients with trichotillomania. These self inflicting habits should be addressed by a psychiatrist for the best possible outcomes.

Diagnosis of trichotillomania is clinical and and more often than not, no labwork is required to confirm its diagnosis.  Occasionally a skin biopsy may be necessary to rule out other causes of patchy hair loss, such as alopecia areata, cicatricial alopecia or fungal infections.

Most patients suffering from trichotillomania need behavioral therapy, but some may require medications such as selective serotonin reuptake inhibitors (SSRIs) to assist in breaking the habit.  Medical or behavioral treatments for stress reduction is also recommended for many patients.  Hair transplants are not recommended for patients suffering from trichotillomania due to the high likelihood of its sufferes pulling out the newly transplanted hair just as they had initially with their natural hair.  In most patients, trichotillomania hair loss can be reversible as long as the compulsive disorder is sucessfully treated.  A hair transplant can be used to restore balding or thinning patches that never completely recovered, but a hair transplant for trichotillomania is only recommended after months or years following the complete resolution of its sufferer’s compulsive hair pulling episodes.

Q:

Hi Doc! How are you?

I have question regarding my hair loss problem. I’ve noticed it just 3 weeks back. As I’ve been reading your infomercial regarding the causes of hair loss. I think I am categorizing my problem to Alopecia Areata where I have one circled affected areas on the right of my front hairline & 2 at the right side at the back of my head. Before that it was small and now it is becoming bigger day by day.

Hope you could help me to find a solution of my problem. Thanks a lot! Hope to hear from you soon!!!
More power!!!

A:

Alopecia areata (AA) in its typical form is easily distinguished from typical patterned male and female hair loss.  Obviously, you need to be examined by a hair specialist or a dermatologist to confirm the diagnosis.  Alopecia areata generally present itself with a patchy or circular (coin shaped) balding spot and could be seen in almost anywhere in the skin.  The lesions are confined to their primary spots with no sign of hair loss in neighboring areas.  Some authorities have recommended steroid injections to facilitate the improvement of the lesions.  However, spontaneous recovery is seen in most patients with no interventions.

In contrast, hair loss pattern in male or female patterned hair loss is more widespread with the hair miniaturization (thinning) advancing to the neighboring areas.  Hair transplantation is not indicated in alopecia areata while it could be the only permanent solution in most cases of patterned baldness.

Q:

Dear Doctor,

I am 14 years old and I have hair loss in form of CTTA and my parents agreed to let me get the hair transplant, but will it actually take months for my hair to grow and I need to know how much it cost for the operation please.

A:

Congenital Temporal Triangular Alopecia (CTTA) is a congenital condition that is noted by parents at birth or soon after that.  CTTA could easily be treated with hair transplantation at any age.  At US Hair Restoration, we charge patients with the number of grafts and since patients with CTTA only need a small number of grafts, the cost falls into our minimum charge category. Having said that you need to have a consultation with us so we can confirm the diagnosis and make sure you are a good candidate for a hair transplant surgery.

Transplanted hair will grow in 2 to 3 months after hair restoration surgery and will become even better than that for the following months after that.  Since the location of the transplanted hair is only in the temple areas, it may not show as much since most people can easily comb their hair to cover the hair loss area.

Please feel free to call our office at 1 (888) 302-8747 and schedule your complementary consultation at one of our Southern California offices. If you are contacting from other states, you can send us an inquiry through our website and we contact you to complete your online consultation.
We look forward to seeing you soon.

Dr. Parsa Mohebi

Click blow to see a before and after photo gallery of a patient with Congenital Temporal Triangular Alopecia (CTTA):

We just had a hair transplant surgery for a child with Congenital Temporal Triangular Alopecia (CTTA) yesterday. He had a patch of baldness since birth and it started to bother him at school recently to the degree that he could not even wait until winter break – the time his parents originally planned to get it restored. The procedure went well and we densely packed 470 follicular unit grafts onto the bald patch of his temple area. He is happy and looking forward to the final growth of the grafts in a few months.

Congenital Temporal Alopecia is a patchy hair loss condition which is generally present at birth in form of a patch of hair loss on the child’s temple. The balding patch may consist of very fine hair. This non-scarring alopecia has been reported to respond well to hair transplant surgery.