Beyond A One-Size-Fits-All : Care for Trichotillomania Needs Rethinking

A study published in the International Journal of Dermatology—“Exploring Pharmacological Treatment for Trichotillomania: Do We Need Better Education?” by Krajewski et al 2024—offers a clear and timely insight into the limitations of our current global health system.

Drawing on treatment data from over 110,000 patients across Europe and the US, the study revealed a highly inconsistent and fragmented approach to managing trichotillomania by health professionals— validating what many sufferers of the condition have long known- that this is a complex condition which remains poorly understood in clinical settings.

The findings expose significant shortfalls in care. For example, the US data showed minimal change in how patients were treated after a diagnosis, noting hat many clinicians continue to offer generic treatment options with little to no adaptation or targeted intervention based on how the conditions actually manifests or displays in an individual..

More broadly, the study found that treatment decisions varied considerably depending on geography and clinician background, rather than being driven by a unified understanding of the condition. This highlights the absence of formal guidelines and the lack of professional education on how to treat trichotillomania effectively. It also suggests that, for many patients, their experience of care depends more on where they happen to live than on what they actually need.

Trichotillomania itself is highly individual in nature. Some people pull their hair in response to anxiety or stress, while others may do so out of boredom or excitement. Each aspect of the condition can differ greatly from person to person. Yet despite this variability, the system continues to default to generalised treatment models— sometimes built around outdated assumptions rather than evidence.

This disconnect between clinical practice and patient experience points to a broader systemic failure. When care is not tailored to reflect how conditions actually present in the real world, outcomes suffer—and trust in the system erodes.

The message from this research is clear. We need to move beyond one-size-fits-all approaches and build a health system capable of recognising and responding to complexity. That means better data, stronger clinical education, consistent standards of care, and a shift toward truly individualised treatment strategies.

Trichotillomania may be under-recognised, but this is a case study on how our systems can—and must—do better.