拔毛癖的诊断与治疗研究进展

doi:10.3877/cma.j.issn.2095-655X.2025.03.001

拔毛癖(TTM)又称拔毛障碍、拔毛症，以反复、难以克制的拔毛冲动，导致脱发，并由此引发显著的功能损害或心理痛苦为临床特征。其诊断主要依靠详细的病史采集、皮肤检查及辅助检查，应与引起脱发的躯体疾病(斑秃、雄激素性脱发及其他医学原因导致的毛发脱落)及其他精神疾病(孤独症谱系障碍、其他强迫及相关障碍、精神分裂症或其他原发性精神病性障碍等)相鉴别。TTM的治疗包括药物治疗、心理行为治疗及物理治疗等，但有些疗法仅为病例报道，应进行多中心、随机对照研究以进一步验证其疗效，为TTM的优化治疗提供科学依据。本文系统回顾TTM的概念变迁与诊断分类、流行病学、发病机制、临床表现、诊断及鉴别诊断、共病、治疗等，为临床诊疗提供借鉴。

关键词: 拔毛癖, 诊断, 药物治疗, 心理行为治疗, 物理治疗

Trichotillomania(TTM), also known as hair pulling disorder or hair pulling syndrome, is characterized by the repeated and uncontrollable urge to pull one′s own hair which results in hair loss, causing significant functional impairment or psychological distress.Its diagnosis mainly relies on detailed medical history collection, skin examination, and auxiliary examinations.It should be distinguished from physical diseases (alopecia areata, androgenetic alopecia, and hair loss caused by other medical reasons) and other mental illnesses(autism spectrum disorder, other obsessive-compulsive and related disorders, schizophrenia or other primary psychiatric disorders, etc.) that cause hair loss. The treatment of TTM includes medication therapy, psychological and behavioral therapy, physical therapy. However, some therapies are merely based on case reports. Multi-center, randomized controlled trials should be conducted to further validate efficacy, and provide a scientific basis for optimizing the treatment of TTM. This paper systematically reviews the conceptual changes and diagnostic classification, epidemiology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, comorbidities and treatment of TTM, providing a reference for clinical diagnosis and treatment.

Key words: Trichotillomania, Diagnosis, Pharmacological treatment, Psychological and behavioral therapy, Physical therapy

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Research advances in the diagnosis and treatment of trichotillomania