LETTER
Alopecia Associated with Fluconazole Therapy
Neil H. Shear, MD
15 July 1996 | Volume 125 Issue 2 | Page 153
TO THE EDITOR:
The article by Pappas and colleagues [1] would have been more accurately called "Telogen Effluvium Caused by Systemic Fungal Infection." Telogen effluvium (or defluvium) [2] is an often-dramatic diffuse loss of hair from the scalp that results from a disproportionately large number of follicles simultaneously entering the resting telogen stage of the hair cycle. This condition classically occurs 2 to 4 months after a stressful event such as pregnancy, infection, or trauma. Systemic fungal illness could be included among such stressful events, and the observation that patients began to lose hair a median of 3 months after initiation of fluconazole therapy suggests a causal relation. Drugs can cause hair loss, often by abrupt cessation of mitotic activity that results in a condition called anagen effluvium [3]. This effect is frequently seen with antineoplastic agents, usually occurs within the first few weeks of therapy, and would not be an appropriate diagnosis for the syndrome described in the article by Pappas and colleagues.
The first step in determining a valid association between a drug and an adverse event is the accurate diagnosis of the event [4]. Without a full description and evaluation of the hair loss seen in these patients and without an appropriate assessment of causality, we can only conclude that this report resubstantiates the well-known association between systemic illness and telogen effluvium.
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Author and Article Information
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University of Toronto Medical School, Toronto, Ontario M4N 3M5, Canada
1. Pappas PG, Kauffman CA, Perfect J, Johnson PC, McKinsey DS, Bamberger DM, et al. Alopecia associated with fluconazole therapy. Ann Intern Med. 1995; 123:354-7.
2. Bertolino AP, Freedberg IM. Disorders of epidermal appendages and related disorders. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF, eds. Dermatology in General Medicine. 4th ed. New York: McGraw-Hill; 1993:685-6.
3. Pillans PI, Woods DJ. Drug-associated alopecia. Int J Dermatol. 1995; 34:149-58.
4. Shear NH. Diagnosing cutaneous adverse reactions to drugs. Arch Dermatol. 1990; 126:94-7.
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