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October 2, 1967

Psychiatric Treatment for Alopecia Totalis

JAMA. 1967;202(1):73. doi:10.1001/jama.1967.03130140131038

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To the Editor:—  In QUESTIONS AND ANSWERS (200:188, 1967) Dr. Howard T. Behrman presented a comprehensive answer to the question on the medical treatment (also advising psychiatric investigation) of alopecia totalis, concluding that "the most effective therapeutic modality at this time consists in the employment of a suitable transformation (ie, a wig)." Because alopecia totalis occurs most often in men, this "treatment" is not entirely effective since the loss of eyelashes and eyebrows present additional problems, particularly to people who work and must function in the business and social world. Also the embarrassment concerning the lack of axillary, pubic, and chest hairs diminishes a man's selfesteem as a masculine figure.Early and thorough psychiatric treatment by a trained psychiatrist is very much in order since most recalcitrant cases are triggered and perpetuated by emotional causes. There often is a history of preceding episodes of alopecia areata ( also of emotional