Practical Pediatric Dermatology by Arnold P. Oranje Nawaf Al-Mutairi & Tor Shwayder

Author:Arnold P. Oranje, Nawaf Al-Mutairi & Tor Shwayder
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Keywords

Hair disease in childrenAlopeciaTrichotillomaniaKipling’s principleHair pulling

Trichotillomania (hair pulling) is a disorder in which an individual repeatedly pulls his or her own hair, often to the point of noticeable alopecia. Although it was first described as long ago as 1889 by Hallopeau, it remains a frequently misunderstood, underdiagnosed, and often ineffectively treated disorder (Oranje et al. 1986).

Over the past decade, there has been increasing focus on trichotillomania, mainly in psychiatric and psychological circles. Several trichotillomania-specific instruments have been developed and implemented to better understand the psychopathology, treatments, and outcomes of this condition. However, the striking physical manifestations of trichotillomania mean that patients are often initially presented to physicians who are not trained in the field of mental health. In this field, the medical and dermatological literature on trichotillomania remains scarce. Even less is known about the disorder in children who are perhaps the most vulnerable population of trichotillomania sufferers.

If children or parents admit to hair pulling and the clinical presentation is concordant, then the diagnosis is clear. However, childhood trichotillomania is often difficult to diagnose due to the secretive nature of hair pulling, patients not being forthcoming with information, and underdiagnosis by medical professionals. In children, the additional dimension of parental denial of the child’s self-induced problem further masks the diagnosis. Thus when faced with a child with non-scarring alopecia of uncertain etiology, the differential diagnosis must be explored for other underlying causes of hair loss. There is a need for a simple and easily applicable diagnostic and management approach that can be utilized in the clinic when faced with such a scenario.

The Kipling’s principle, also known as the “5W1H” method, is a systematic problem-solving procedure which utilizes a set of questions whose answers are considered to be basic in information gathering. It challenges existing perceptions and opens new perspectives on the problem. The application of this method has been advocated for approaching conditions in which clinical information may similarly be masked, such as physical abuse in children (Bilo et al. 2013). It has never been applied in trichotillomania or in other habit disorders or self-mutilation.

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