Akademik Veri Yönetim Sistemi
21st Congress of the European Society of Dermatology and Psychiatry & 1st World Congress of Psychodermatology, İstanbul, Türkiye, 28 - 31 Mayıs 2025, cilt.19, ss.31, (Özet Bildiri)
Aim: Psychodermatology explores the relationship between the skin and the mind in a holistic way. In this case, we aim to highlight psychodermatological conditions by discussing the diagnosis and treatment of a patient presenting with both symptoms of trichotillomania and trichodynia. Case Report: A 58-year-old divorced woman with a middle school education was referred by dermatology clinic to the consultation-liaison psychiatry unit due to complaints of hair-pulling. Her symptoms had started nine months prior, about a month after receiving the second dose of the Pfizer-BioNTech vaccine. The behavior, primarily occurring at night, involved itching and hair pulling without full awareness. She expressed shame about her behavior, which led her to shave her head and begin wearing a headscarf. Additionally, she reported symptoms of sadness, lack of motivation, insomnia, and irritability. During the mental status examination, she was observed to have short, uneven hair, localized areas of alopecia, depressive thought content, and a depressed mood. Blood tests revealed no pathological findings. With a preliminary diagnosis of trichotillomania, she was prescribed fluoxetine 20 mg/day, along with behavioral recommendations. During a four-month period of follow-up, despite sequential treatment with fluoxetine, sertraline, escitalopram, and mirtazapine, the patient showed no response to therapy. Upon further detailed history-taking, she described an indescribable discomfort in the areas where her hair touched her face and scalp, including sensations of burning, stinging, tingling, and pain. She pulled her hair to relieve these sensations, which were also triggered by contact with various fabrics. Given a new preliminary diagnosis of trichodynia accompanying trichotillomania, hydroxyzine 25 mg/day was added to her treatment alongside escitalopram 10 mg/day. After starting hydroxyzine, her itching, hair-pulling, and sensory complaints significantly decreased, and she began to grow her hair again. Conclusion: Trichotillomania is characterized by hair-pulling behavior that leads to impaired functioning and hair loss. As seen in this case, depressive symptoms often accompany the disorder, with an incidence of around 50%. In terms of pharmacotherapy, there is limited evidence supporting the use of various antipsychotics and dronabinol, while selective serotonin reuptake inhibitors have shown no significant effect. Trichodynia is a cutaneous sensory syndrome characterized by abnormal skin sensations, such as itching, burning, stinging, and tingling on the scalp. Treatment options for trichodynia include pregabalin, gabapentin, doxepin, sertraline, amitriptyline, topical steroids, and hydroxyzine. In this case, the patient benefited from the addition of hydroxyzine after the detection of trichodynia symptoms that triggered her hair-pulling behavior. Given the frequent coexistence of psychodermatological disorders, a thorough evaluation is essential to establish an effective treatment plan.