#POV You’re The Doctor (Dermatology/Psychiatry): Season 3, Episode 4. Follow for the next episode 🙏🏼 Answer: C – CBT. This young girl with a repetitive history of hair loss around her crown and eyebrows is suggestive of Trichotillomania – a compulsive hair-pulling disorder! In the same family of OCD, Trichotillomania is characterized by repetitive hairpulling of the scalp, eyebrows, and eyelashes, resulting in differing length spots of baldness (a shorter area being from a recent episode of pulling compared to a longer). The episodes tend to be around times of stress or anxiety, in her case when she has a big game coming up, as a habit. Allergens, while unlikely to cause significant hair loss, would still show even length patches (A). While thoughts of parasites or fungi should be considered in a school-aged patient, they would most likely result in significant itching and there would likely be reports of others in the class/team with similar symptoms (B). Trichotillomania is treatable! The best treatment for Trichotillomania is a combination of antidepressants and cognitive therapy1. As this patient has already takes medications for her depression, the best next step would be to suggest starting cognitive behavioral therapy (CBT) to start practicing habit reversal before permanent damage to the hair starts! References: Öst LG, Havnen A, Hansen B, Kvale G. Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014.. Clin Psychol Rev. 2015; 40: p.156-69. #doctor#dermatology#psychiatry#doctor#medicine#healthcare#medschool#premed#medstudent#jakegoodman
#POV You’re The Doctor (Dermatology/Psychiatry): Season 3, Episode 4. Follow for the next episode 🙏🏼 Answer: C – CBT. This young girl with a repetitive history of hair loss around her crown and eyebrows is suggestive of Trichotillomania – a compulsive hair-pulling disorder! In the same family of OCD, Trichotillomania is characterized by repetitive hairpulling of the scalp, eyebrows, and eyelashes, resulting in differing length spots of baldness (a shorter area being from a recent episode of pulling compared to a longer). The episodes tend to be around times of stress or anxiety, in her case when she has a big game coming up, as a habit. Allergens, while unlikely to cause significant hair loss, would still show even length patches (A). While thoughts of parasites or fungi should be considered in a school-aged patient, they would most likely result in significant itching and there would likely be reports of others in the class/team with similar symptoms (B). Trichotillomania is treatable! The best treatment for Trichotillomania is a combination of antidepressants and cognitive therapy1. As this patient has already takes medications for her depression, the best next step would be to suggest starting cognitive behavioral therapy (CBT) to start practicing habit reversal before permanent damage to the hair starts! References: Öst LG, Havnen A, Hansen B, Kvale G. Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014.. Clin Psychol Rev. 2015; 40: p.156-69. #doctor #dermatology #psychiatry #doctor #medicine #healthcare #medschool #premed #medstudent #jakegoodman