title: Trichotillomania in Children.
abstract: BACKGROUND
  Trichotillomania is an often underdiagnosed condition. Little is known about trichotillomania in childhood. We aimed to analyze the characteristics of children with trichotillomania to increase information on this condition.
  
  
  METHODS
  A retrospective study of an electronic database was performed in a tertiary children's hospital. Information from patients with trichotillomania was systematically classified under the categories 'who', 'what', 'when', 'where', 'why', and 'how'.
  
  
  RESULTS
  A total of 33 patients had a diagnosis of trichotillomania (28 females, 5 males; peak age between 3 and 4 years). Scalp involvement was most common and nail biting was observed in 5 patients. Only 51.5% of patients had parents who noticed their child's hairpulling. Hair on or under the bed was the most common clue suggesting that hairpulling occurred. Triggering factors identified in 16 children included physical appearance, family-related issues, school-related issues, and concurrent illness. The noninvasive hair pull test was negative in all children. There was a high non-follow-up rate, and treatment outcomes varied.
  
  
  CONCLUSIONS
  A set of 6 specific questions, based on the '5Ws and 1H' principle, facilitates the gathering of important information on children with unexplained nonscarring hair loss and helps clinicians be cognizant of possible outcomes of trichotillomania. This will be especially useful to clinicians who are not familiar with this elusive condition.
authors.affiliation: Division of Dermatology, University Medicine Cluster, National University Hospital, Singapore, Singapore.
authors.forename: Nisha Suyien
authors.initials: NS
authors.lastname: Chandran
authors.affiliation: PsyQ Psycho-Medical Programs, Programs Psychotrauma, Personality Disorders and Anxiety Disorders, Breda, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Novak
authors.affiliation: Private Practice, Dermatology, Bellinzona, Switzerland.
authors.forename: Matilde
authors.initials: M
authors.lastname: Iorizzo
authors.affiliation: Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Grimalt
authors.affiliation: Department of Dermatology, Maasstad Hospital Rotterdam and Dermicis Alkmaar, Rotterdam, The Netherlands.
authors.forename: Arnold P
authors.initials: AP
authors.lastname: Oranje
keywords: Alopecia; Childhood; Hair; Hairpulling; Pediatric trichotillomania; Treatment