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Background: Trichotillomania, also known as hair-pulling disorder, is a chronic psychiatric condition with a fluctuating course in which an individual pulls out their hair, leading to visible hair loss and psychosocial sequelae. Due to the unknown pathogenesis, the treatment of this disorder is complex and remains a challenge for dermatologists and psychiatrists. Since guidelines for treating trichotillomania are lacking and, consequently, no common treatment strategy exists, we decided to perform a large-scale, global retrospective cohort study to assess the characterized real-world prescription patterns in treating trichotillomania., Methods: The research used the TrinetX database for patients with trichotillomania (ICD 10 - F63.3) within the European and the United States Collaborative Network (EC and UC, respectively). After consulting with a psychodermatology expert, a list of 25 medications was investigated., Results: Data on the prescription drugs of 1,275 patients from the EC and 109,741 patients from the UC were collected. In both the EC and UC cohorts, benzodiazepine derivatives, particularly lorazepam and midazolam, were the most commonly prescribed sedatives/hypnotics. Antipsychotic prescriptions, primarily haloperidol, followed benzodiazepines. After the trichotillomania diagnosis, notable changes in drug prescriptions for the EC cohort, including an increased likelihood of receiving acetylcysteine, haloperidol, quetiapine, sertraline, olanzapine, and risperidone were observed. The UC cohort showed minimal changes. Overall, both cohorts leaned toward benzodiazepine prescriptions (37% UC, 21% EC) and had limited antidepressant usage. Haloperidol (19.3%) and quetiapine (15.1%) were commonly prescribed in both cohorts., Conclusions: The results of our study indicate that the real-world prescription patterns for trichotillomania differ significantly from the expert-proposed therapeutic approach and point toward the necessity of creating standards of pharmacological care and better education., (© 2024 the International Society of Dermatology.)

Human hair, particularly on the scalp, serves as a significant aspect of social identity and well-being. The exposome, encompassing both intrinsic and extrinsic factors, plays a fundamental role in hair weathering. Intrinsic factors include genetic predispositions and physiological changes within the body, while extrinsic factors comprise environmental exposures such as UV radiation, pollution, humidity, temperature variations, lifestyle choices, and chemical treatments. These elements collectively contribute to the cumulative damage experienced by hair over time. Understanding the comprehensive impact of the exposome on hair health and hair aging necessitates an exploration of various environmental conditions, lifestyle factors, and technical artifacts. Despite advancements in research, the intricate mechanisms underlying the exposome influence on hair remain incompletely understood. Through a comprehensive review of current literature and emerging research findings, this study aims to enhance the understanding of exposome impact on hair health., (Copyright © 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)