Onabotulinum toxin A used to treat trichotillomania and trigeminal trophic syndrome

<h3></h3> A 63-year-old lady status post-excision of acoustic neuroma with chronic migraine on onabotulinum toxin A (OBTA) therapy for migraine developed traumatic excoriations in the right temple and perioral region secondary to trigeminal trophic syndrome. The standard OBTA protocol for migraine was extended to areas around the excoriations, leading to remarkable healing of the ulcerations. This patient, with a known history of psychiatric conditions later developed trichotillomania in the bilateral temporal and crown regions. She admitted to habitual pulling on the right side due to a lack of sensation from her trigeminal trophic syndrome. The patient requested further OBTA injections in the areas of alopecia as she believed it ameliorated the desire to pull hair. An additional 50 units of OBTA was administered, 5 units per site, at the margins of the trichotillomania induced alopecia. At a 3 month follow-up, the patient claims hair growth in the affected areas and continues to receive OBTA injections for the scalp in addition to her routine migraine dosing. Botulinum toxin has known antinociceptive effects by blocking the release of peripheral neurotransmitters and inflammatory mediators from sensory nerves, which could explain the efficacy of OBTA and could indicate a possible use in trichotillomania. Consent for this publication was obtained from the patient.