**4.3 Alopecia and schizophrenia**

Schizophrenia is a serious psychiatric disorder with impaired ability to evaluate reality, hallucinations and delusions, disorganized thoughts and behaviors. In a case-control study conducted with 5117 patients in Taiwan, alopecia areata was found to be less common in schizophrenia, unlike other psychiatric diseases [24]. Case reports in this area are also limited. Years ago, Kubota et al. reported three cases of zotepine-induced alopecia areata, one schizophrenic and two bipolar, and the symptoms improved upon reduction or discontinuation of the zotepine dose [65]. In a recent case-control study of alopecia areata in the USA, the authors reported a higher incidence of schizophrenia and other psychotic disorders among patients with alopecia areata [27]. On the other hand, a large case-control study involving 5117 alopecia areata patients in Taiwan reported contrasting findings and showed a negative association between alopecia areata and schizophrenia [24]. A study conducted in Israel comparing 41,055 patients with alopecia areata to a control group found that schizophrenia was negatively associated with alopecia areata in both men and women [66]. It is not known how schizophrenia protects against alopecia areata. This area seems open to research.
