What Causes Unusual Eyelash Loss in Young Adults?

What you need to know

• Trichotillomania is a mental health condition where a person feels compelled to pull out their own hair, including eyelashes.
• It can be mistaken for other medical conditions that cause hair loss, so careful diagnosis is important.
• Treatment usually involves a combination of psychological therapy and sometimes medication.

Understanding trichotillomania and eyelash loss

When we think about hair loss, we often picture thinning on the scalp. However, some people experience hair loss in less common areas, like the eyelashes. This case study explores an unusual situation where a young woman was losing her eyelashes due to a condition called trichotillomania.

Trichotillomania is a mental health disorder where a person feels an irresistible urge to pull out their own hair. While it often affects the scalp, eyebrows, or body hair, this case shows it can also target eyelashes.

The patient’s story

The study focuses on an 18-year-old woman who came to an eye clinic because she had been losing her eyelashes for about three weeks. Her parents explained that she was pulling out her own eyelashes whenever they grew back. The young woman described feeling intense itching, which led her to remove the lashes - sometimes by pulling them out, and other times by trimming them with scissors. She said this brought her relief from the itching sensation.

The diagnostic process

When doctors examined the patient, they found several important clues:

1. Her eyelids looked thicker than normal.
2. There were patches where eyelashes were completely missing.
3. In other areas, there were short, broken lashes at different lengths.

The doctors also noticed specific signs that pointed to trichotillomania:

• Black dots where hairs had broken off
• A “V sign” where two broken hairs came from the same follicle
• A “tulip sign” where some hairs were shaped like tulip flowers

These signs helped distinguish trichotillomania from other conditions that can cause eyelash loss, such as alopecia areata (a type of autoimmune hair loss).

Differentiating trichotillomania from other conditions

It’s important to understand that several medical conditions can cause eyelash loss. Doctors need to carefully rule out these other possibilities before diagnosing trichotillomania. Some conditions they considered in this case included:

Blepharitis

This is an inflammation of the eyelids that can cause eyelash loss. It usually comes with other symptoms like redness, flaking skin around the eyes, and a gritty feeling. The patient in this case didn’t have these additional signs.

Alopecia areata

This autoimmune condition causes hair loss in patches. It can affect eyelashes, but usually shows different patterns than what the doctors saw in this case.

Hyperthyroidism

An overactive thyroid gland can sometimes lead to hair loss, including eyelashes. Blood tests showed this patient’s thyroid function was normal.

Other skin conditions

Conditions like seborrheic dermatitis or atopic dermatitis can cause eyelash loss, but there were no signs of widespread skin issues in this case.

The combination of the patient’s history (admitting to pulling out the lashes) and the specific signs observed led the doctors to diagnose trichotillomania.

Understanding trichotillomania

Trichotillomania is classified as an impulse control disorder. People with this condition experience an irresistible urge to pull out their hair, even though they know it can cause damage. Some key points about trichotillomania:

• It often begins in the pre-teen or teenage years.
• Stress or anxiety can trigger or worsen the behavior.
• Many people with trichotillomania report a sense of tension before pulling, and relief afterward.
• The behavior can be conscious or almost automatic.
• It can lead to noticeable hair loss and emotional distress.

In children, trichotillomania is often a temporary phase triggered by stress (like a new sibling or problems at school). However, when it starts in the pre-teen to young adult years, as in this case, it tends to be a more chronic condition that may relapse over time.

Treatment approaches

Managing trichotillomania usually requires a team approach, involving mental health professionals as well as medical doctors. Some common treatment strategies include:

Behavioral therapy

Cognitive-behavioral therapy (CBT) and habit reversal training are often the first-line treatments. These approaches help patients:

• Identify triggers for hair-pulling urges
• Develop alternative coping strategies
• Address underlying anxiety or stress

Medication

In some cases, medications may be helpful. These can include:

• N-acetyl cysteine (an amino acid supplement)
• Selective serotonin reuptake inhibitors (SSRIs, a type of antidepressant)
• Tricyclic antidepressants

Combination approaches

Often, a mix of therapy and medication provides the best results.

Addressing underlying conditions

If trichotillomania is linked to other mental health issues like depression or anxiety disorders, those conditions need to be treated as well.

Topical treatments

In some cases, doctors may prescribe topical medications to help regrow hair in affected areas. For eyelashes specifically, a medication called bimatoprost has shown some promise.

The importance of early diagnosis

This case highlights why it’s crucial to recognize trichotillomania early. Quick diagnosis allows for:

• Prompt referral to mental health professionals
• Earlier start of effective treatments
• Prevention of long-term hair loss or scarring
• Reduction of emotional distress for the patient

Conclusions

• Trichotillomania can affect any body hair, including eyelashes.
• It’s important to distinguish it from other medical causes of hair loss.
• Treatment usually involves a combination of behavioral therapy and sometimes medication.
• Early diagnosis and a multidisciplinary approach offer the best chance for successful management.