Alopecia and nail changes associated with voriconazole therapy

Clin Infect Dis. 2014 Aug 1;59(3):e61-5. doi: 10.1093/cid/ciu275. Epub 2014 May 22.


Background: Voriconazole was 1 of 2 antifungal agents recommended for treatment of fungal infections associated with injection of contaminated methylprednisolone. Alopecia and nail changes are not commonly reported side effects of voriconazole. Having noted increasing hair loss among our patients treated with voriconazole, we sought to determine the prevalence and characteristics of alopecia associated with this agent.

Methods: Patients who received voriconazole for at least 1 month for probable or confirmed fungal infection were eligible to complete a survey regarding alopecia and nail changes. For those patients who reported alopecia, additional questions about reversal of hair loss were asked after voriconazole had been stopped for at least 3 months.

Results: A total of 152 of 175 eligible patients (87%) completed the survey. One hundred twenty-five (82%) reported alopecia. Hair loss on the scalp was noted in 120 (96%), arms and legs in 52 (42%), and eyebrows and eyelashes in 47 each (38%). Nineteen patients (15%) reported wearing a wig or hat because of extensive hair loss. Alopecia developed a mean (standard deviation) of 75 (54) days after initiation of voriconazole. Of 114 patients who were off voriconazole for at least 3 months, hair loss had stopped in 94 (82%) and regrowth had begun in 79 (69%), including those who were changed to either itraconazole or posaconazole. Nail changes or loss occurred in 106 (70%) patients.

Conclusions: Alopecia and nail changes were common adverse effects associated with voriconazole therapy during the multistate fungal outbreak.

Keywords: alopecia; fungal infections; multistate meningitis outbreak; nail changes; voriconazole.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alopecia / epidemiology*
  • Alopecia / etiology
  • Alopecia / microbiology
  • Antifungal Agents / adverse effects
  • Antifungal Agents / therapeutic use
  • Cross-Sectional Studies
  • Disease Outbreaks*
  • Female
  • Humans
  • Male
  • Methylprednisolone / administration & dosage*
  • Michigan / epidemiology
  • Middle Aged
  • Mycoses / drug therapy*
  • Nails / drug effects*
  • Nails / microbiology
  • Prevalence
  • Triazoles / therapeutic use*
  • Voriconazole / adverse effects*
  • Voriconazole / therapeutic use


  • Antifungal Agents
  • Triazoles
  • posaconazole
  • Voriconazole
  • Methylprednisolone