SHM Converge Scientific Abstract ePoster Gallery-Pulled to the Bone: Severe Trichotillomania Leading to Calvarial Osteomyelitis

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This case report describes a 60-year-old woman with severe trichotillomania, a psychiatric disorder involving compulsive hair pulling, complicated by a large 6 x 3 cm full-thickness parietal scalp defect with exposed skull and suspected calvarial osteomyelitis. Although she had no fever, leukocytosis, or obvious wound infection, MRI showed calvarial enhancement concerning for bone infection. She had previously failed surgical wound closures because of repeated self-trauma.<br /><br />A multidisciplinary team including Plastic Surgery, Neurosurgery, Infectious Disease, and Psychiatry concluded that biopsy or reconstruction would likely fail unless her hair-pulling behavior was controlled first. Psychiatry diagnosed severe trichotillomania with comorbid depression and anxiety and adjusted her medications, leading to improvement in mood and a reduction in hair pulling. She was discharged with wound care, a 2-week course of doxycycline and levofloxacin, and a plan for habit-reversal therapy. Definitive surgical management was deferred until psychiatric stabilization.<br /><br />The report emphasizes that trichotillomania can cause serious medical complications beyond alopecia and skin irritation, including chronic wounds, deep infection, full-thickness scalp defects, and rare but dangerous calvarial osteomyelitis. This condition carries risks such as chronic infection, bone necrosis, abscess, and possible intracranial spread. The authors stress that standard wound management and antibiotics are unlikely to succeed without stopping the self-injury. Early multidisciplinary collaboration and behavioral treatment are essential to improve outcomes and prevent recurrence.

Asset Subtitle

Liana Alcaro

Meta Tag

Author List Leenah Abojaib, Liana Alcaro, Michael Jones

Category Clinical Vignettes

Concept Trichotillomania

Concept Calvarial Osteomyelitis

Concept Full-Thickness Scalp Defect

Concept Multidisciplinary Care

Concept Patient Stabilization

Distinguished Non-Finalist

Presenter Organization Emory

Presenting Author Liana Alcaro

Track Adult

Keywords

trichotillomania

compulsive hair pulling

scalp defect

calvarial osteomyelitis

exposed skull

psychiatric disorder

multidisciplinary care

habit-reversal therapy

wound care

self-injury

Trichotillomania

Calvarial Osteomyelitis

Full-Thickness Scalp Defect

Multidisciplinary Care

Patient Stabilization