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Psychocutaneous Disorders
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Kristen Russomanno, Vesna M. Petronic-Rosic
Hairs are sometimes ingested causing a mass within the intestines which is referred to as a trichobezoar. In severe cases, trichobezoars may obstruct the intestines and cause associated gastrointestinal symptoms that may be apparent on evaluation.
Psychological Aspects of Hair Loss
Published in Rubina Alves, Ramon Grimalt, Techniques in the Evaluation and Management of Hair Diseases, 2021
Andjela Egger, Antonella Tosti
There are several groups of primary purely psychiatric/psychological disorders resulting in hair loss such as self-induced diseases, somatoform disorders, social phobias, obsessive-compulsive disorders, and personality disorders. Self-induced diseases include diagnosis of trichotillomania, trichotemnomania, trichoteiromania, trichodaknomania by proxy, trichorrhizophagia, trichobezoar, and skin-picking syndrome (Table 15.1). Somatoform disorders include diagnosis of somatization disorder, hypochondriac disorder, body dysmorphic disorder, and persistent somatoform pain disorder. Personality disorders leading to hair loss include obsessive personality disorder and narcissistic personality disorder. Detailed definitions and descriptions of these disorders can be found in a thorough review by Harth et al. [2].
Stomach and duodenum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Trichobezoar (hair balls) (Figure63.34) are unusual and are virtually exclusively found in female psychiatric patients, often young. It is caused by the pathological ingestion of hair, which remains undigested in the stomach. The hair ball can lead to ulceration and gastrointestinal bleeding, perforation or obstruction. The diagnosis is made easily at endoscopy or, indeed, from a plain radiograph. Treatment consists of removal of the bezoar, which may require open surgical treatment. Phytobezoars are made of vegetable matter and found principally in patients who have gastric stasis. Often this follows gastric surgery.
Trichobezoar presenting as an acute abdominal obstruction in a 17-year-old girl
Published in Paediatrics and International Child Health, 2022
Zuhal Bayramoglu, Rana Gunoz Comert, Basak Erginel, Abdulkadir Baziki
Bezoar obstruction of the small intestine and giant bezoar in the stomach are rare causes of vomiting in adolescents and young adults and require surgical removal. Foreign bodies swallowed by pre-school-age children include toys, while adolescents may repeatedly ingest organic foreign bodies. Mental retardation or psychiatric disorders are usually the basis of these behavioural disorders [7]. Bezoars may require admission to hospital owing to non-specific findings such as an inability to gain weight, growth retardation, anaemia, vomiting and abdominal tenderness. In the presence of dyspeptic symptoms such as vomiting and regurgitation, if there is an enlarged stomach on imaging, bezoars in the gastric lumen should be considered; other causes include pyloric stenosis and superior mesenteric artery syndrome. Since bezoars are formed from indigestible food residue, they are of soft tissue density on radiography, but contrast with the air surrounding the bezoar in the enlarged intestinal lumen may provide a clue to the diagnosis [8]. Children with iron deficiency should be carefully evaluated as the deficiency may progress owing to mucosal irritation. Bezoars can also be caused by pica [9]. In this case, significant anaemia (<8 g/dL) did not develop, despite the large size of the trichobezoar.
Pharmacotherapy for trichotillomania in adults
Published in Expert Opinion on Pharmacotherapy, 2020
Christine Baczynski, Verinder Sharma
When left untreated, TTM can have a detrimental effect on an individual’s mental and physical wellbeing. A study by Stemberger et al. found that over 70% of the patients reported significant feelings of shame, irritability, and low self-esteem related to their hair pulling [35]. Over 80% of patients in the same study reported feeling depressed or unattractive because of their illness. Other studies have shown that patients report several impairments in the areas of social and occupational functioning, such as decreased quality of interpersonal relationships and interference with daily job duties [1,10,35]. Trichotillomania can also have negative physical consequences, such as inflammation of hair follicles and surrounding skin and complications that arise from trichophagia [31] (eating the hair that has been pulled) in some patients, such as gastrointestinal issues and development of a dangerous and potentially life-threatening blockage in the intestinal tract known as a trichobezoar [36].
Review of epidemiology, clinical presentation, diagnosis, and treatment of common primary psychiatric causes of cutaneous disease
Published in Journal of Dermatological Treatment, 2018
J. A. Krooks, A. G. Weatherall, P. J. Holland
Patients with TTM recurrently pull out their hair, resulting in prominent hair loss and significant distress and/or functional impairment (95). The median time spent engaging in behavior is 45 min/day (range 15–240 min) (96). Patients predominantly pull hair from the scalp (83%) (97). Other regions implicated include eyelashes, eyebrows, and pubic, face, and body hair (98). Trichophagia (swallowing hair after pulling it out) is observed in over 20% of patients and may result in a life-threatening trichobezoar (hairball) that may block the intestine and require emergency surgery (99). Patients may present with abdominal or chest pain, change in bowels, unexplained weight loss, and/or vomiting. Abdominal CT scan is diagnostic in 97% of cases (95). Typical age at onset is 10–13 years. There is a 4:1 adult women: male prevalence and an equal gender distribution in children (95). Prior studies have reported a prevalence of 0.6%; however, the prevalence is likely higher considering patients’ reluctance to reveal behavior and updated, less stringent diagnostic criteria (95).