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The 2012 outbreak of fungal infections associated with injections of contaminated methylprednisolone affected about 750 patients, most of whom developed meningitis, paraspinal abscesses, or both. These infections were caused mostly by the rare mold Exserohilum rostratum, and treatment involved high doses of the antifungal voriconazole. Physicians at a hospital in Michigan heard complaints so frequently about thinning hair and nails from patients with these infections that they devised and administered a formal questionnaire.
Among 152 patients who had received voriconazole for ≥1 month, 125 (82%) reported alopecia, most commonly on the scalp, arms and legs, and eyebrows or eyelashes; loss of facial, axillary, chest, and pubic hair also was n…