Psiquiatricas

Question 1

A 43-year-old female presents with missing lashes from her eyelids and stubs of lashes of different lengths. Examination of her scalp, body, eyelids, and eyes does not reveal any other abnormalities or loss of any other hair. What is the likely diagnosis?

1. Alopecia areata
2. Trichotillomania
3. Demodex infestation
4. Conjunctivitis

Answer 1

2 - Trichotillomania

• Irregular loss of lashes with lashes present in stubs of different lengths usually indicates self-induced lash pulling or trichotillomania.
• Patients with trichotillomania will deny pulling their lashes and at times may not be aware that they are doing it. The eyelids will not show any disease or inflammation. Patients may be obsessive-compulsive and generally, need a psychiatric workup and help. However, it is always important to review and reexamine these patients, always being on the lookout for any other underlying condition that may be present.
• Alopecia areata can affect the eyelids but the loss of the lashes is more diffuse, without stubs of hair.
• Infections and infestations of the eyelid can cause individual lash abnormality and eyelid margin inflammation but not loss of lashes.

Question 2

35: A 17-year-old female is brought in by her parents for hair loss. The patient herself is not worried. The exam shows the part in her hair is widened with decreased hair density. The hair in the area is coarse and of multiple different lengths. Gentle traction does not pull out any hairs. The skin of the scalp has some light brown scales. The eyelashes show varying lengths. Which of the following would be the most appropriate question?

1. Have you had a perm recently?
2. Do you color your hair?
3. Do you twirl or pull your hair?
4. Do you have a desire to eat paper or dirt?

Answer 2

3 - Do you twirl or pull your hair?

• The patient most likely has trichotillomania, an impulse control disorder where the patient pulls out his or her own hair.
• It is often done unconsciously or in one’s sleep.
• This is best treated with behavior modification as medication has not been shown to be very effective.
• Selective serotonin reuptake inhibitors are most commonly used but tricyclic antidepressants are also effective.