Retinoic Acid Is Not Involved in Fluconazole-Induced Alopecia: Evaluation in a Human Cohort and Rat Model

Cutaneous effects associated with fluconazole in patients treated for coccidioidomycosis

“…One theory is that fluconazole interacts with the cytochrome P450 enzyme system, leading to increased levels of endogenous retinoids . However, a more recent study showed that retinoic acid levels were not increased in the plasma and tissue of rats and humans given fluconazole . Anecdotally, we agree with the other authors’ observations that severe fluconazole‐related adverse effects, including alopecia and other cutaneous effects, seem to improve when the fluconazole dose is reduced by 50% or stopped altogether .…”

“…15 However, a more recent study showed that retinoic acid levels were not increased in the plasma and tissue of rats and humans given fluconazole. 16 Anecdotally, we agree with the other authors' observations that severe fluconazole-related adverse effects, including alopecia and other cutaneous effects, seem to improve when the fluconazole dose is reduced by 50% or stopped altogether. 9,12 However, our current study findings did not show fewer or less severe symptoms in the small number of patients taking a lower fluconazole dose.…”