{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T14:14:04Z","timestamp":1777558444365,"version":"3.51.4"},"reference-count":37,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,5,1]]},"abstract":"<jats:p>Trichotillomania is a relatively common cause of childhood alopecia. We report our observations of 10 children with trichotillomania seen over a 2-year period at Texas Children's Hospital. Patient ages ranged from 9 to 14 years (mean: 11.3 years) with an equal gender ratio. The duration of hair-pulling ranged from 1 month to 10 years (median: 4.6 months). The scalp alone was affected in 8 cases, the scalp and eyelashes in 1 case, and the eyelashes alone in 1 case. The frontal scalp and vertex were the most common sites affected. Associated findings included nail-biting in 2 cases, \u201cpicking\u201d of the skin in 1 case, and headaches in another case. Noted precipitating factors in 3 patients included \u201cstress\u201d at home and school. Associated psychopathology included major depression in 1 case, attention-deficit\/hyperactivity disorder in 1 case, and an \u201canxious and nervous personality\u201d in 1 case. The most important differential diagnosis to exclude from trichotillomania is alopecia areata, which was seen concomitantly in 1 patient and preceded the onset of hair-pulling by 11 months. Eight patients were referred to a child psychologist for additional management, of which 2 were subsequently treated with antidepressant medication. Trichotillomania is a disorder of multifaceted pathology, and an interdisciplinary approach to management is often helpful. The common prepubertal age of onset provides an important opportunity for the pediatrician to lend support to affected patients and their families.<\/jats:p>","DOI":"10.1542\/peds.113.5.e494","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:53:04Z","timestamp":1092444784000},"page":"e494-e498","source":"Crossref","is-referenced-by-count":91,"title":["Trichotillomania in Childhood: Case Series and Review"],"prefix":"10.1542","volume":"113","author":[{"given":"Yong-Kwang","family":"Tay","sequence":"first","affiliation":[{"name":"Department of Dermatology, Changi General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moise L.","family":"Levy","sequence":"additional","affiliation":[{"name":"Pediatrics, Texas Children's Hospital, Houston, Texas"},{"name":"Departments of Dermatology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise W.","family":"Metry","sequence":"additional","affiliation":[{"name":"Pediatrics, Texas Children's Hospital, Houston, Texas"},{"name":"Departments of Dermatology"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2004,5,1]]},"reference":[{"key":"2021121010073715900_R1","unstructured":"Hallopeau H. 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