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Ghani H, Podwojniak A, Tan IJ, Fliorent R, Jafferany M. From tugs to treatments: a systematic review on pharmacological interventions for trichotillomania. Clin Exp Dermatol 2024; 49:774-782. [PMID: 38376368 DOI: 10.1093/ced/llae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/28/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Trichotillomania (TTM) is a psychiatric disorder with dermatological consequences, characterized by recurrent hair pulling. It affects 1-3% of the population, and often coexists with other psychiatric disorders, leading to emotional distress. Effective management of TTM can be challenging because of underdiagnosis, symptom heterogeneity and stigma. Pharmacological interventions, including selective serotonin reuptake inhibitors and N-acetyl cysteine (NAC) are commonly used. OBJECTIVES To assess the existing literature on pharmacotherapy for TTM and identify potential avenues for future research and treatment advancements. METHODS A systematic review of the literature was performed using PubMed and Scopus databases within the past 10 years (PROSPERO: CRD42023454009). Included studies assessed pharmacotherapy for TTM and provided insights into current evidence and potential directions for future research and treatment advancements. RESULTS In total, 23 articles were identified that met inclusion criteria. The most successful interventions were NAC, aripiprazole and monoamine oxidase inhibitors. NAC was identified as the most impressive adjunctive therapy to selective serotonin reuptake inhibitors and behavioural therapies in treatment through its mechanism of decreased glutamate-induced excitatory neuronal damage, with adjunctive antioxidant properties. Most of the other therapeutics that were identified require further research and controlled trials to validate their findings. CONCLUSIONS Even if successful therapeutic outcomes are achieved, it is important to consider the patient's comorbidities and to combine pharmacological interventions with behavioural therapy interventions to comprehensively manage TTM.
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Affiliation(s)
- Hira Ghani
- Northwestern University Department of Dermatology, Chicago, IL, USA
| | | | - Isabella J Tan
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
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Mandarino MJ, Stummer L, Trueba AF, Vahia I, Freedberg A. Review of Management Considerations for Excoriation Disorder in Older Adults. Am J Geriatr Psychiatry 2024; 32:879-894. [PMID: 38538517 DOI: 10.1016/j.jagp.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 06/11/2024]
Abstract
Excoriation disorder (ED) is defined as compulsive skin picking that results in skin damage and emotional distress. Optimal management of ED includes individualized treatment plans consisting of psychotherapies, behavioral and pharmacologic interventions. Compared with younger populations, older adults are at increased risk for poor outcomes, such as infection and hospitalization, and require unique management considerations. Risk factors that contribute to disease burden include age-related changes to the skin and underlying medical and psychiatric comorbidities. A literature review was conducted on ED yielding limited evidence exclusive to older adults. The authors suggest a therapeutic approach to ED in older adults based on available evidence and experience from inpatient and outpatient psychiatric settings. Finally, opportunities for future research are highlighted.
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Affiliation(s)
| | | | - Ana F Trueba
- McLean Hospital (MJM, LS, AFT, IV, AF), Belmont, MA; Harvard Medical School (AFT, IV, AF), Boston, MA; Universidad San Francisco de Quito (AFT), Quito, Ecuador
| | - Ipsit Vahia
- McLean Hospital (MJM, LS, AFT, IV, AF), Belmont, MA; Harvard Medical School (AFT, IV, AF), Boston, MA
| | - Alexis Freedberg
- McLean Hospital (MJM, LS, AFT, IV, AF), Belmont, MA; Harvard Medical School (AFT, IV, AF), Boston, MA; ConcertoCare (AF), New York, NY
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Nina Dominguez L, Imbernón-Moya A, Saceda-Corralo D, Vano-Galván S. Trichotillomania Treatment Update. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00419-8. [PMID: 38768806 DOI: 10.1016/j.ad.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024] Open
Abstract
Trichotillomania (TTM) is an obsessive-compulsive disorder in which affected individuals recurrently pull-out hair from any region of the body, causing hair loss or alopecia. The management of TTM is a therapeutic challenge for dermatologists and consists of a combination of pharmacological and non-pharmacological alternatives. Cognitive-behavioral therapy has successfully been used to treat TTM. However, not all patients are willing to follow this treatment strategy. Unconventional support tools are proposed, such as electronic devices, internet therapies and microneedling. N-acetylcysteine and memantine are considered suitable first-line therapies thanks to their favorable safety and efficacy profile, low risk of adverse effects, and significant benefits. The use of other drugs, including fluoxetine, clomipramine, olanzapine, and naltrexone has limited evidence of variable efficacy. The present review illustrates the current treatment modalities for the management of TTM.
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Affiliation(s)
- L Nina Dominguez
- Servicio de Dermatología, Instituto Dermatológico Dominicano y Cirugía de Piel «Dr. Huberto Bogaert Díaz», Santo Domingo, República Dominicana.
| | - A Imbernón-Moya
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Madrid, Spain; Trichology Unit, Grupo de Dermatología Pedro Jaén, Madrid, España
| | - D Saceda-Corralo
- Trichology Unit, Grupo de Dermatología Pedro Jaén, Madrid, España; Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Biología de Sistemas, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, España
| | - S Vano-Galván
- Trichology Unit, Grupo de Dermatología Pedro Jaén, Madrid, España; Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Biología de Sistemas, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, España
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Johnsen N, Poppens M, Cheng K. Acne excoriée: Diagnostic overview and management. Int J Dermatol 2024; 63:565-571. [PMID: 38102842 DOI: 10.1111/ijd.16964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/18/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
Acne excoriée (AE) is a skin picking disorder (SPD) within the group of obsessive compulsive (OCD) and related disorders characterized by the compulsive manipulation of acne lesions. AE typically appears in females during adolescence or young adulthood and can cause significant disfigurement and psychosocial impairment. This disorder is under-recognized due to patient discomfort to disclose excoriation habits or lack of behavior awareness. It is imperative that dermatologists accurately diagnose and treat this disorder to minimize long-term damage to the skin. This review aims to provide an overview of the diagnosis and treatment options for AE.
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Affiliation(s)
- Nicole Johnsen
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - McKayla Poppens
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Kyle Cheng
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
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Christensen RE, Jafferany M. Unmet Needs in Psychodermatology: A Narrative Review. CNS Drugs 2024; 38:193-204. [PMID: 38386200 DOI: 10.1007/s40263-024-01068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
Psychodermatology, the multidisciplinary field that explores the intricate interplay between the mind and the skin, has gained increasing recognition over the past decade. However, several knowledge gaps and unmet needs persist in the field. The objective of this narrative review was to investigate the unmet needs in the field of psychodermatology as they pertain to medical training, treatment, research, and care access. PubMed was searched from inception through December 2023 to identify articles related to psychodermatology. Findings revealed several unmet needs within the field of psychodermatology. First, there is a need for further investigation into the pathophysiology that links psychological stress to cutaneous disease including the development of novel therapies targeting key neuropeptides. Second, the existing literature focuses primarily on the pharmacologic treatment of body dysmorphic disorder and body-focused repetitive behaviors, as well as delusional parasitosis, for which the first-line agents are selective serotonin reuptake inhibitors and atypical antipsychotics, respectively. However, additional research into the efficacy and safety of the remaining psychotropic medications and the treatment of other common psychocutaneous diseases is required. Finally, there exists a significant gap in knowledge amongst clinicians tasked with treating psychocutaneous diseases. Dermatologists report low rates of training in psychodermatology and discomfort with prescribing psychotropic medications. In conclusion, increasing resources for dermatologist education on psychotropic agent use, development of new drugs targeting stress-induced skin conditions, and research on the psychocutaneous applications of current medications may greatly improve the quality and access of psychodermatology care.
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Affiliation(s)
- Rachel E Christensen
- Department of Psychiatry and Behavioral Sciences, Central Michigan University College of Medicine/CMU Medical Education Partners, Saginaw, MI, 48603, USA
- Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, IL, 60611, United States
| | - Mohammad Jafferany
- Department of Psychiatry and Behavioral Sciences, Central Michigan University College of Medicine/CMU Medical Education Partners, Saginaw, MI, 48603, USA.
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Mackay CE. Trichotillomania: a perspective synthesised from neuroscience and lived experience. BMJ MENTAL HEALTH 2023; 26:e300795. [PMID: 37734751 PMCID: PMC11146365 DOI: 10.1136/bmjment-2023-300795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023]
Abstract
Trichotillomania, or hair-pulling disorder, is one of a family of disorders called body-focused repetitive behaviours (BFRBs), which also include disordered skin-picking (dermotillomania) and nail-biting (onychophagia). The disorders affect 1%-2% of the population, cause high levels of distress and have high levels of comorbidity with other psychiatric diagnoses. The key facts and figures are briefly reviewed and some important points are further explored: (1) BFRBs are associated with psychological distress, but are distinct from other diagnoses, (2) The pathological behaviours mirror excessive self-grooming behaviours in other species, and may relate to immune-system mediated feedback loops, and (3) The resulting behaviours are stigmatised and cause intense shame and isolation for those who suffer, which might in itself maintain the feedback loop. These observations lead to the hypothesis that the core disorder is one of pathological grooming, which may have a basis in an immune response, with shame being both a consequence and a maintainer of the disorder. The major barrier to testing the hypotheses and potential interventions remains the stigma that keeps these disorders, and those who suffer from them, in the shadows.
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