ALOPECIA ASSOCIATED WITH FLUCONAZOLE THERAPY

Objective: To describe the association between fluconazole and reversi ble alopecia. Design: A retrospective survey of 1) patients enrolled i n NIAID Mycoses Study Group (MSG) protocols involving the long-term us e of fluconazole for treatment of endemic mycoses and 2) patients trea ted with fluconazole outside of a protocol setting but by the MSG inve stigators who were MSG members. Setting: 26 MSG sites in the United St ates. Patients: 33 patients with various deep and superficial mycoses who developed alopecia while receiving fluconazole. Results: 11 of 26 investigators reported a total of 33 patients with substantial alopeci a related to fluconazole therapy, Underlying mycoses included blastomy cosis, sporotrichosis, histoplasmosis, cryptococcosis, coccidioidomyco sis, and mucosal candidiasis. In separate MSG studies, 17 of 136 (12.5 %) and 8 of 40 (20%) patients had substantial reversible alopecia asso ciated with fluconazole therapy. Eight patients who were not in the pr otocol had similar adverse effects. Twenty-nine of 33 patients (88%) r eceived at least 400 mg of fluconazole daily for a mean of 7. 1 months . Alopecia developed a median of 3 months after initiation of fluconaz ole therapy and involved the scalp in all patients. Other sites were i nvolved in about one third of patients. Three patients required wigs b ecause of extensive hair loss. Alopecia resolved within 6 months of di scontinuation of fluconazole therapy or reduction of the daily dose by at least 50%. Conclusions: Alopecia appears to be a common adverse ev ent associated with higher-dose (400 mg/d) fluconazole given for 2 mon ths or longer. This effect may be severe but is reversed by discontinu ing fluconazole therapy or substantially reducing the daily dose.