Onabotulinum Toxin A Used to Treat Trichotillomania and Trigeminal Trophic Syndrome

A 63-year-old woman with a history of acoustic neuroma and chronic migraine, treated with onabotulinum toxin A (OBTA), experienced healing of ulcerations caused by trigeminal trophic syndrome after extending her OBTA treatment. She later developed trichotillomania, particularly in areas with reduced sensation, and requested additional OBTA injections, believing they reduced her urge to pull hair. After receiving 50 units of OBTA at the alopecia margins, she reported hair growth at a 3-month follow-up. The antinociceptive effects of OBTA, which block neurotransmitter and inflammatory mediator release, may explain its potential efficacy in treating trichotillomania.