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      Tricotilomanía: investigando una patología desapercibida Translated title: Trichotillomania: searching an unnoticed pathology

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          Abstract

          La tricotilomanía es un trastorno psíquico primario, que ocasiona una alopecia no cicatrizal autoprovocada y se ubica en el grupo de los trastornos obsesivo-compulsivos. La tricotilomanía se puede clasificar dentro de las llamadas dermatitis "artefactas". Suele ser más frecuente de lo que se pensaba; es motivo actual de investigación por la co-morbilidad asociada a otras patologías psicogénicas. A pesar de ser observada más comúnmente en niños y adolescentes, esta conducta anormal, repetida y estereotipada de manipular, traccionar y arrancar los pelos de alguna zona pilosa del cuerpo puede ocurrir a cualquier edad. Es importante el diagnóstico oportuno para evitar complicaciones médicas y psiquiátricas posteriores. La terapia psicológica y el empleo de psicofármacos para el control de este padecimiento, representan un verdadero reto terapéutico.

          Translated abstract

          Trichotillomania is a self-induced nonscarring alopecia classified as an impulsive control disorder but with features of both obsessive-compulsive disorder and addictive disorders, that has recently received research attention. It appears to be more common than previously believed. Although most frequent in children, this repetitive hair pulling out of one's own hair can occur at any age. Psychogenic excoriations, nail-biting and other abnormal behaviors can be associated. It is important that the diagnosis is early and exact avoiding medical and psychiatric complications. Therapy for trichotillomania can be challenging.

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          Most cited references35

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          Diagnostic and Statistical Manual

          (1994)
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            MRI-based morphometric topographic parcellation of human neocortex in trichotillomania.

            The purpose of the present study was to test specific hypotheses regarding volumetric changes of the neocortex between 10 female trichotillomania (TTM) subjects and 10 female normal controls. A standard three-dimensional (3-D) brain coordinate system was imposed over each newly acquired native magnetic resonance imaging (MRI) scan for positional normalization and 3-D shape/geometric localization analyses were based on the midpoints of anterior and posterior commissures, and the longitudinal fissure. The brain segmentation method, using well-characterized semiautomated intensity and differential contour algorithms by signal intensity-frequency histograms, was used blind to segment the principal gray and white matter structures. The segmented neocortical ribbon was subdivided into 48 regions (i.e. parcellation units) per hemisphere via a new method of morphometric topographic parcellation. There were no significant volumetric changes of the precentral gyrus, postcentral gyrus, supplementary motor cortex or opercular cortex in TTM patients compared with control subjects. A broader analysis as a hypothesis-generating post-hoc effort showed that TTM subjects exhibited significantly reduced left inferior frontal gyrus volume of 27% (t = 2.21, d.f. = 18, P = 0.04) and enlarged right cuneal cortex volume of 40% (t = -2.30, d.f. = 18, P = 0.03) compared to normal controls. This is the first report of a structural neocortex abnormality in TTM. Results are discussed in terms of the behavioral specialization of these two brain neocortical regions and the complex interractions between visual and sensorimotor cortices. The results also showed the feasibility of the MRI-based morphometric topographic parcellation for investigation of the human neocortex in neuroscience research.
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              Somatization disorders in dermatology.

              This paper reviews a wide range of somatization-related symptoms that are encountered in dermatology. These include the unexplained cutaneous sensory syndromes especially the cutaneous dysesthesias associated with pain, numbness and pruritus; traumatic memories in post-traumatic stress disorder (PTSD) which are experienced on a sensory level as 'body memories' and may present as local or generalized pruritic states, urticaria and angioedema; and unexplained flushing reactions and profuse perspiration, in addition to unexplained exacerbations of stress-reactive dermatoses such as psoriasis and atopic eczema secondary to the autonomic hyperarousal in PTSD; classic 'pseudoneurologic' symptoms associated with dissociation including unexplained loss of touch or pain, in addition to the self-induced dermatoses such as dermatitis artefacta and trichotillomania that are encountered with dissociative states; and body dysmorphic disorder where the patient often presents with a somatic preoccupation involving the skin or hair.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rad
                Revista argentina de dermatología
                Rev. argent. dermatol.
                Asociación Argentina de Dermatología (Ciudad Autónoma de Buenos Aires )
                1851-300X
                June 2012
                : 93
                : 2
                : 21-32
                Affiliations
                [1 ] Instituto Materno-Infantil del Estado de México Mexico
                [2 ] Universidad Autónoma del Estado de México Mexico
                [3 ] Universidad Autónoma del Estado de México Mexico
                [4 ] Hospital Liga Contra el Cáncer
                [5 ] Hospital Centro Médico Sampedrano, CEMESA Honduras
                [6 ] Instituto Materno-Infantil del Estado de México Mexico
                Article
                S1851-300X2012000200003
                d25fbf43-45f3-4058-b5af-bd2151705ede

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Argentina

                Self URI (journal page): http://www.scielo.org.ar/scielo.php?script=sci_serial&pid=1851-300X&lng=en
                Categories
                DERMATOLOGY

                Dermatology
                Trichotillomania,Obsessive-compulsive disorder,Anxiety,Ansiedad,Tricotilomanía,Trastorno obsesivo-compulsivo

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