N-acetyl Remains an Option for Adults with Trichotillomania
Trichotillomania is a hair pulling disorder. I have reviewed the DSM Criteria have been reviewed in the past.
Current evidence suggests that habit reversal training may be among the most consistently effects treatments for helping patients with trichotillomania. Pharmacologic agents with N-acetyl cysteine, chlomipramine and olanzapine may be helpful based on trials to date.
NAC is a good option for many practitioners to consider for adults patients given its good safety. Nause and GI upset can occur but are not common. Behavioural therapy and treatment of associated psychiatric and psychological issues should not be ignored.
N -acetyl cysteine in Children with TTM: Does it help?
Studies have shown that N -acetyl cysteine can be a helpful strategy for some adults patients with trichotillomania. Unlike the data in adults, data in children and adolescents have not suggested a clear benefit.
Bloch et al. 2013
Bloch and colleagues from Yale set out to examine the efficacy of N-acetylcysteine (NAC) for the treatment of pediatric trichotillomania (TTM) in a double-blind, placebo-controlled, add-on study. There were 39 children and adolescents aged 8 to 17 years with pediatric trichotillomania were randomly assigned to receive NAC or matching placebo for 12 weeks. The primary outcome of the study was a change in severity of hairpulling as measured by the Massachusetts General Hospital-Hairpulling Scale (MGH-HPS). Secondary measures assessed hairpulling severity, automatic versus focused pulling, clinician-rated improvement, and comorbid anxiety and depression.
Interestingly, there were no significant difference between N-acetylcysteine and placebo was found on any of the primary or in any of the secondary outcome measures. Many subjects significantly improved with time regardless of treatment assignment. In the NAC group, 25% of subjects were judged as treatment responders, compared to 21% in the placebo group.
Overall the authors felt that, unlike in adults, there was no clear for NAC for the treatment of children with trichotillomania.
Popova L and Mancuso J 2022
Popova and Mancuso present a report of a 17 year old male patient who had a nice response to NAC.
The patient described in the report was a 17-year-old male presented to clinic with a history of recurrent hair twirling and persistent hair loss. His hair was recently shaved in an effort to stop twisting his hair and he had a large area of alopecia with irregular borders. When he presented to clinic, he was about to finish 3 months of CBT. CBT had helped his underlying depression and anxiety but not made an impact on hair rubbign and touching and twisting the hair.
The authors point out that the patient’s habit of rubbing at his head and touching his hair persisted, even after shaving his hair short twice. CBT had not helped the trichoteiromania (desire to rub the scalp).
The authors started a a dose of 600mg twice daily, increasing to 1200mg twice daily as tolerated. After 6 months, our patient reported decreased desire to twirl his hair and his hair had almost completely regrown