The Potential of N-Acetylcysteine for Treatment of Trichotillomania, Excoriation Disorder, Onychophagia, and Onychotillomania: An Updated Literature Review
Abstract
:1. Introduction
2. Materials and Methods
3. NAC Considerations
4. NAC in Trichotillomania
5. NAC in Excoriation Disorder
6. NAC in Onychophagia and Onychotillomania
7. Discussion
8. Limitations and Future Directions
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Summary of NAC Treatment Studies in Trichotillomania | |||||||
---|---|---|---|---|---|---|---|
Study | Design | Patients | Age (Year) | Comorbidities | NAC Dose | Other Concurrent Medications | Outcomes |
Grant, Odlaug, and Kim (2009) [30] | RDBPCT | Adult (n = 50) | 18–65 | Depression, anxiety, OCD, PTSD, SPD, bulimia | 1200–2400 mg/day | SSRIs, SNRIs, stimulants, psychotherapy | The NAC group showed higher efficacy (F1,47 = 32.152, p < 0.001) compared to the placebo group based on MGH-HPS. The NAC group also showed improvement in hair pulling severity (F1,47 = 18.245, p < 0.001) and resistance and control (F1,47 = 37.067, p < 0.001) compared to placebo. |
Bloch et al. (2013) [31] | RDBPCT | Pediatric (n = 39) | 8–17 | ADHD, depression, anxiety, OCD, tic disorder, SPD | 600–2400 mg/day | SSRIs, antipsychotics, atomoxetine, psychotherapy | No significant difference between NAC and placebo group based on MGH-HPS (p = 0.55). Moderate decrease in hair pulling noted in both groups (p = 0.002). |
Zhao et al. (2021) [33] | Case report | Adult (n = 1) | 25, F | BED, anxiety, depression | 600–1800 mg/day | Fluvoxamine 150 mg/day, bupropion 300 mg/day | After 2 weeks, stable mood and reduced hair pulling behavior reported. At 14 weeks, patient reported no hair pulling or binge eating episodes, and improved anxiety and depression. |
Jones, Keuthen, and Greenberg (2018) [34] | Case report | Adult (n = 1) | 18, F | OCD, depression, anxiety, SPD | 2700 mg/day | Fluoxetine 40 mg/day, psychotherapy | After 16 weeks, patient had significant reduction in hair pulling, skin picking, depression, anxiety, and OCD symptoms. Full remission was not reached. |
Kilic and Keles (2018) [35] | Case report | Adult (n = 1) | 18, F | Depression, anxiety | 1200 mg/day | Fluoxetine 40 mg/day | After 3 weeks, patient showed decreased hair pulling urges and behavior. All depression and anxiety symptoms ceased. At 6-month follow-up, no hair pulling was noted. |
Pino et al. (2017) [36] | Case report | Pediatric (n = 1) | 12, F | Not specified | 2400 mg/day | Doxepin 10 mg/day, fluoxetine 20 mg/day, pimozide 2 mg/day | After 6 months, patient had improved hair density and dermoscopy findings. |
Barroso et al. (2017) [37] | Case report | Pediatric (n = 1) | 11, M | Asthma, atopic dermatitis | 1200–1800 mg/day | None | After 3 months, patient showed improvement at 1200 mg/day. Remission with complete hair regrowth was achieved at 1800 mg/day for 3 months. |
Ozcan and Seckin (2016) [38] | Case report | Adult and pediatric (n = 2) | 30, F; 14, F | Not specified; ADHD | 1200 mg/day | None; methylphenidate | Case 1: After 2 months, hair pulling decreased with complete remission within 4 months. No recurrence of hair pulling was noted at 7-month follow-up. Case 2: After 2 weeks, significant improvement of hair pulling noted with complete hair regrowth after 6 months. No recurrence of hair pulling noted at 8-month follow-up. |
Taylor and Bhagwandas (2014) [39] | Case report | Adult (n = 1) | 58, F | Unexplained weight loss | 1200 mg/day | None | After 4 weeks, patient showed noticeable regrowth of hair, which further improved at 10 weeks. Progress continued and maintained at 32 weeks. |
Rodrigues-Barata et al. (2012) [40] | Case report | Adult (n = 2) | 23, F; 19, F | Alopecia; Not specified | 1200 mg/day | None | Case 1: Within 2 months, hair regrowth was observed; Case 2: Complete regrowth was observed after 3 months of treatment. |
Odlaug and Grant (2007) [41] | Case report | Adult (n = 2) | 28, M; 40, F | ADHD, nail biting; Not specified | 600–1800 mg/day; 600–2400 mg/day | None | Case 1: Dose was increased from 600 to 1800 mg/day over several weeks. Complete cessation of hair pulling after 1 week on 1800 mg/day. Case 2: Dose was increased from 600 to 2400 mg/day. Complete cessation of urges and hair pulling after 2 weeks on 2400 mg/day. |
Summary of NAC Treatment Studies in Excoriation Disorder. | |||||||
---|---|---|---|---|---|---|---|
Study | Design | Patients | Age (Year) | Comorbidities | NAC Dose | Other Concurrent Medications | Outcomes |
Grant et al. (2016) [46] | RDBPCT | Adult (n = 66) | 18–65 | Depression, anxiety, TTM, nail biting | 1200–3000 mg/day | Psychotropic medications | After 12 weeks, NAC treatment group showed significant improvement in skin picking severity compared to placebo based on NE-YBOCS and CGI-Serverity scale (p = 0.048, p = 0.03). |
Hwang, Campbell, and Sartori-Valinotti (2021) [47] | Retrospective cohort study | Adult (n = 28) | Mean: 57.2 | Not specified | 1200–2400 mg/day | Doxepin, duloxetine | After 12 weeks, 61.5% of patients reported a positive response to NAC. |
Miller and Angulo (2013) [48] | Open-label pilot study | Adult and pediatric (n = 35) | 5–39 | Prader—Willi syndrome | 450–1200 mg/day | Valproic acid, quetiapine, risperidone, spironolactone, growth hormone, metformin, levothyroxine, modafinil | After 12 weeks, 100% of patients reported reduced skin picking behavior and 71% achieved complete resolution. |
Wieting et al. (2021) [49] | Retrospective cohort study | Adult (n = 14) | 17–53 | Prader—Willi syndrome | 1800–2400 mg/day | Risperidone, pipamperone, aripiprazole, sertraline, milnacipran | After 12 weeks, 6 patients reported no changes in symptoms and 2 had worsened symptoms based on CGI-Improvement scale. |
Ozcan (2021) [50] | Case report | Adult (n = 2) | 75, F; 36, F | Not specified | 1200 mg/day | None | Case 1: After 2 weeks, patient reported decreased skin picking. Treatment was continued for 3 months and no relapse at 6-month follow-up. Case 2: After 6 weeks, complete cessation skin picking reported and no relapse at 3-month follow-up. |
Kilic and Keles (2019) [35] | Case report | Adult (n = 1) | 42, F | Depression | 1200 mg/day | Venlafaxine 225 mg/day | After 10 days, patient reported decreased skin picking symptoms. Complete cessation of skin picking achieved at 3 months. |
Silva-Netto et al. (2014) [51] | Case report | Adult (n = 3) | 45, F; 40, F; 31, F | TTM, depression; Bipolar disorder; Depression, pathological jealousy, internet addiction | 1200–1800 mg/day; 1200 mg/day; 1200 mg/day | Venlafaxine 75 mg/day; lithium 600 mg/day, quetiapine 50 mg/day; fluoxetine 20 mg/day | Case 1: Skin picking resolved completely. Case 2: Complete resolution of skin picking achieved and maintained for 10 months. Case 3: Substantial improvement of skin picking. |
Percinel and Yazici (2014) [52] | Case report | Pediatric (n = 1) | 12, F | Not specified | 600–1800 mg/day | None | 4 weeks after a dose increase from 600 to 1200 mg/day, skin picking urges and behavior decreased dramatically and complete remission achieved after 4 weeks on 1800 mg/day. |
Odlaug and Grant (2007) [41] | Case report | Adult (n = 1) | 52, F | Bulimia nervosa, compulsive buying | 600–1800 mg/day | None | Patient reported 50% decrease of picking urges and behaviors within 1 week after dose increase from 600 to 1200 mg/day. Patient had no skin picking behavior after a dose increase to 1800 mg/day. |
Summary of NAC Treatment Studies in Onychophagia | |||||||
---|---|---|---|---|---|---|---|
Study | Design | Patients | Age (Year) | Comorbidities | NAC Dose | Other Concurrent Medications | Outcomes |
Ghanizadeh et al. (2013) [58] | RDBPCT | Pediatric (n = 42) | 6–18 | OCD, depression, anxiety, ADHD, tic disorder, SPD | 200–800 mg/day | SSRIs, SNRIs, stimulants, antipsychotics, TCAs | Significantly increased nail length in treatment group compared to placebo after 1 month (p < 0.04). No significant difference noted after 2 months. |
Kilic and Keles (2019) [35] | Case report | Adult (n = 1) | 24, M | Not specified | 1200–1800 mg/day | None | After 3 weeks on 1800 mg/day, patient lost urge to bite his nails. Efficacy was maintained after 6 weeks. |
Ghanizadeh and Derakhshan (2012) [59] | Case report | Pediatric (n = 1) | 8, M | Autism | 800 mg/day | Risperidone 2 mg/day and thioridazine 10 mg/day | After 1 month of NAC, patient’s parents reported reduced nail biting and autism symptoms. |
Berk et al. (2009) [60] | Case report | Adult (n = 3) | 46, F; 44, F; 46, M | Bipolar disorder; Depression, anxiety, bipolar disorder; Depression, bipolar disorder | 2000 mg/day; 2000 mg/day; Not specified | Lithium 900 mg/day, quetiapine 300 mg/day; Mirtazapine 15 mg; None | Case 1: After 2 weeks, patient completely stopped nail biting and results were maintained at 7-month follow-up; Case 2: After 4 months, patient completed stopped nail biting and results were maintained at 2-month follow-up; Case 3: After 28 weeks, patient reported reduction in nail biting. |
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Lee, D.K.; Lipner, S.R. The Potential of N-Acetylcysteine for Treatment of Trichotillomania, Excoriation Disorder, Onychophagia, and Onychotillomania: An Updated Literature Review. Int. J. Environ. Res. Public Health 2022, 19, 6370. https://doi.org/10.3390/ijerph19116370
Lee DK, Lipner SR. The Potential of N-Acetylcysteine for Treatment of Trichotillomania, Excoriation Disorder, Onychophagia, and Onychotillomania: An Updated Literature Review. International Journal of Environmental Research and Public Health. 2022; 19(11):6370. https://doi.org/10.3390/ijerph19116370
Chicago/Turabian StyleLee, Debra K., and Shari R. Lipner. 2022. "The Potential of N-Acetylcysteine for Treatment of Trichotillomania, Excoriation Disorder, Onychophagia, and Onychotillomania: An Updated Literature Review" International Journal of Environmental Research and Public Health 19, no. 11: 6370. https://doi.org/10.3390/ijerph19116370