Microneedling was a potentially effective, novel treatment approach for trichotillomania that should be evaluated in controlled trials, according to findings in a letter to the editor published in Dermatologic Therapy.
Patients with trichotillomania engage in compulsive hair pulling behaviors often onsetting during late adolescence. It is currently classified as an obsessive compulsive-related disorder in the Diagnostics and Statistical Manual of Mental Disorders, Fifth Edition.
Collaborators from Rutgers Robert Wood Johnson Medical School and Central Michigan University College of Medicine in the United States and the Schambach Hair Clinic in Guatemala sought to evaluate whether microneedling therapy may be a potential treatment for trichotillomania. Microneedling was achieved using a dermaroller — a handheld tool with fixed needles that intentionally creates percutaneous wounds via medical-grade needles. Percutaneous wounds from microneedling stimulate wound-healing and angiogenesis, but use of a dermaroller also “mimics the sensation of hair pulling” that could additionally relieve the obsessive-compulsive urges to hair pull, investigators noted.
To evaluate the potential utility of microneedling in trichotillomania, 3 patients with decreased hair density due to hair pulling were recruited for this case series. Patients were provided with a dermaroller equipped with 0.5 mm needles and instructed to use the device on their scalp when they felt an urge to engage in hair pulling. The patients were also given a daily topical 5% minoxidil foam to stimulate local hair growth.
Patient 1 was a 33-year old woman with trichotillomania onset during adolescence. The patient presented with parietal and temporal hair loss. Patient 2 was a 30-year old woman who developed trichotillomania at 13 years of age. The patient presented with hair loss in the scalp vertex, but symptoms had worsened in the previous 2 years despite antidepressant use and behavioral therapy. Patient 3 was a 15-year old girl who presented with hair pulling in the left frontal and parietal regions of the scalp 4 months previously.
All patients reported good adherence to treatment at 6 and 12 months, respectively, and had clinical improvement, confirmed by trichoscopy.
The major limitation of this study was the small sample size and observational design. These findings should be confirmed in larger, controlled trials, researchers suggested.
Study authors concluded, “Trichotillomania can have a significant negative impact on quality of life in affected patients. Symptoms can be challenging to manage despite treatment, and often require a multi-modal therapeutic approach. The present case series highlights the feasibility, safety, and potential efficacy of microneedling using a dermaroller for both the behavioral and dermatological treatment of trichotillomania.”
Christensen RE, Schamback M, Jafferany M. Microneedling as an adjunctive treatment for trichotillomania. Dermatol Ther. 2022;e15824. doi:10.1111/dth.15824