Fluconazole, a relatively new triazole antifungal agent, is being used increasingly to treat fungal infections because it can be given orally and has a relatively safe toxicity profile. We report a case of a woman who developed alopecia while being treated for a prolonged period with moderate doses of fluconazole.

An asymptomatic 75-year-old woman who had had chronic lymphocytic leukemia since 1988 underwent routine chest radiography before knee surgery, which showed a right lower lobe pulmonary infiltrate. A chest radiograph done 8 months earlier was normal. She was not taking any medications. Bronchoalveolar lavage yielded Cryptococcus neoformans. Bone marrow and cerebrospinal fluid examination results showed no evidence of C. neoformans. The serum cryptococcal antigen titer was 1:16. A diagnosis of cryptococcal pneumonia was made, and oral fluconazole therapy, 400 mg daily, was initiated.

The initial dose of fluconazole produced severe nausea, and the dose was reduced to 200 to 300 mg daily, as tolerated. Complete blood count was unchanged, and liver function test results remained normal. A chest radiograph showed gradual improvement in the pulmonary infiltrate.

After receiving fluconazole for approximately 6 months, she complained of diffuse hair loss. She noted that she was brushing out clumps of hair from her temporal areas, and her hairdresser noted that her hairline had receded. She also had complete hair loss from her eyebrows, forearms, and legs. Axillary and pubic hair was spared. At this time, a chest radiograph showed resolution of the pulmonary infiltrate, and fluconazole therapy was stopped. New hair growth was noted within 3 weeks of discontinuing the fluconazole.

Drug-induced alopecia is a rare adverse effect reported in a limited number of medications such as ß-blockers, lithium, isotretinoin, and tricyclic antidepressants [1-3]. To date, no reports have described hair loss associated with fluconazole. Recently, at the Mycoses Study Group meeting, several cases of alopecia were reported in patients receiving fluconazole for treatment of histoplasmosis and blastomycosis. Most of these patients were receiving high doses of fluconazole (> 400 mg daily) for extended periods of time, and their alopecia generally resolved after discontinuing fluconazole therapy.