Reich Stefanie, Trüeb Ralph M
Dermatologische Klinik, Universitätsspital Zürich, Schweiz.
J Dtsch Dermatol Ges. 2003 Jan;1(1):22-8. doi: 10.1046/j.1610-0387.2003.02012.x.
The physical influences leading to traumatic hair injury may be the result of cosmetic treatments, may be accidental or self-inflicted. The most frequent cause of self-inflected hair loss is trichotillomania, in which the hair is plucked, while trichotemnomania, in which the hair is deliberately cut, is less frequent. Freyschmidt-Paul et al. proposed the term trichoteiromania for yet another type of artificial hair loss, which results from perpetual rubbing of the scalp with fracturing of the hair shafts.
Four patients with trichoteiromania are further characterized on the basis of clinical, morphological and psychopathological criteria.
In contrast to trichotillomania, trichoteiromania has no diagnostic histopathological features and has a normal trichogram. Traumatic changes to the hair shaft are more conspicuous, with splitting at the ends of the hairs, giving the impression of white tips. The underlying mental disorder varis among the patients, though scalp dysaesthesia, not explained through any specific dermatological disorder, is a common denominator in all cases.
While trichotillomania is considered to be an obsessive-compulsive disorder, the underlying mental disorder in trichoteiromania represents a more heterogeneous group. Cooperation with the psychiatrist is indicated, as much as the management and prognosis of trichoteiromania will depend on recognition of the underlying mental disorder and its specific psychotherapeutic and pharmacological treatment.
导致外伤性毛发损伤的物理影响可能是美容治疗的结果,也可能是意外或自我造成的。自我造成脱发最常见的原因是拔毛癖,即拔头发,而断毛癖,即故意剪头发,则较少见。弗雷施密特 - 保罗等人提出了“摩擦性断发癖”这一术语,用于描述另一种人为脱发类型,它是由于持续摩擦头皮导致毛干断裂所致。
根据临床、形态学和精神病理学标准,对4例摩擦性断发癖患者进行了进一步特征描述。
与拔毛癖不同,摩擦性断发癖没有诊断性组织病理学特征,毛发检查结果正常。毛干的外伤性改变更为明显,毛发末端出现分裂,呈现白色尖端的外观。患者潜在的精神障碍各不相同,不过头皮感觉异常(无法通过任何特定皮肤病解释)是所有病例的一个共同特征。
虽然拔毛癖被认为是一种强迫症,但摩擦性断发癖潜在的精神障碍代表了一个更为多样化的群体。鉴于摩擦性断发癖的管理和预后将取决于对潜在精神障碍的认识及其具体的心理治疗和药物治疗,因此需要与精神科医生合作。